Provider Demographics
NPI:1396125779
Name:SCOTT S. JOHNSON D.D.S., PLLC
Entity type:Organization
Organization Name:SCOTT S. JOHNSON D.D.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:STOLLE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-979-0229
Mailing Address - Street 1:7325 S PIERCE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4553
Mailing Address - Country:US
Mailing Address - Phone:303-979-0229
Mailing Address - Fax:303-979-1514
Practice Address - Street 1:7325 S PIERCE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4553
Practice Address - Country:US
Practice Address - Phone:303-979-0229
Practice Address - Fax:303-979-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6594305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service