Provider Demographics
NPI:1427511120
Name:JOHNSON, SARAH LOUISE (RDH, OMT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 VIA DOLCE APT 214
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5024
Mailing Address - Country:US
Mailing Address - Phone:424-835-2759
Mailing Address - Fax:
Practice Address - Street 1:4300 VIA DOLCE APT 214
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5024
Practice Address - Country:US
Practice Address - Phone:424-835-2759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26316124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist