Provider Demographics
NPI:1881707826
Name:JOHNSON, MATTHEW L (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2161
Mailing Address - Country:US
Mailing Address - Phone:903-885-8906
Mailing Address - Fax:903-885-6301
Practice Address - Street 1:1330 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2161
Practice Address - Country:US
Practice Address - Phone:903-885-8906
Practice Address - Fax:903-885-6301
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice