1821355298 NPI number — JOHNSON DENTAL CORPORATION

Table of content: (NPI 1821355298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821355298 NPI number — JOHNSON DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON DENTAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1821355298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 N LA CUMBRE RD
Provider Second Line Business Mailing Address:
STE H
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93110-1577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-960-5600
Provider Business Mailing Address Fax Number:
805-682-8899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 N LA CUMBRE RD
Provider Second Line Business Practice Location Address:
STE H
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93110-1577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-960-5600
Provider Business Practice Location Address Fax Number:
805-682-8899
Provider Enumeration Date:
04/23/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MADDEN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
JULIA
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
805-682-4800

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  53046 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: 60946 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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