Provider Demographics
NPI:1285957928
Name:RAYMONT H. JOHNSON,DDS.INC.
Entity type:Organization
Organization Name:RAYMONT H. JOHNSON,DDS.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMONT
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DD
Authorized Official - Phone:310-671-1234
Mailing Address - Street 1:808 E MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1914
Mailing Address - Country:US
Mailing Address - Phone:310-671-1234
Mailing Address - Fax:310-677-8853
Practice Address - Street 1:808 E MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1914
Practice Address - Country:US
Practice Address - Phone:310-671-1234
Practice Address - Fax:310-677-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25404305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2540401Medicare UPIN