1740306794 NPI number — DR. GREGORY P JOHNSON DDS, MS

Table of content: DR. GREGORY P JOHNSON DDS, MS (NPI 1740306794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740306794 NPI number — DR. GREGORY P JOHNSON DDS, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
GREGORY
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740306794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5394 WALNUT AVE
Provider Second Line Business Mailing Address:
SUITE H
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92604-2505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-552-5800
Provider Business Mailing Address Fax Number:
949-552-8905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5394 WALNUT AVE
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92604-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-552-5800
Provider Business Practice Location Address Fax Number:
949-552-8905
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  D22813 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CGP171091 . This is a "CALIFORNIA CHILDREN'S SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1790054344 . This is a "DENTICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B22813 . This is a "DENTICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CGP097860 . This is a "CALIFORNIA CHILDREN'S SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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