Provider Demographics
NPI:1326866922
Name:DEAN, JOHNNY JUSTIN (RD, LDN)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:JUSTIN
Last Name:DEAN
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 OLDE TOWNE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-9118
Mailing Address - Country:US
Mailing Address - Phone:623-251-9868
Mailing Address - Fax:
Practice Address - Street 1:732 OLDE TOWNE DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-9118
Practice Address - Country:US
Practice Address - Phone:623-251-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86180133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered