Provider Demographics
NPI:1316979537
Name:JOHNSON, DENNIS ALLEN (DMD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:ALLEN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5726 W ORCHID LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-4654
Mailing Address - Country:US
Mailing Address - Phone:503-816-0771
Mailing Address - Fax:
Practice Address - Street 1:5726 W ORCHID LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4654
Practice Address - Country:US
Practice Address - Phone:503-816-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD52721223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health