Provider Demographics
NPI:1578386629
Name:JOHNSON PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:JOHNSON PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTI
Authorized Official - Middle Name:
Authorized Official - Last Name:FARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-628-0511
Mailing Address - Street 1:772 N DIXIE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7444
Mailing Address - Country:US
Mailing Address - Phone:435-628-0511
Mailing Address - Fax:435-215-2815
Practice Address - Street 1:772 N DIXIE DR STE 101
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7444
Practice Address - Country:US
Practice Address - Phone:435-628-0511
Practice Address - Fax:435-215-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental