Provider Demographics
NPI:1427598341
Name:HUYNH, JOHNNY D (DDS)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:D
Last Name:HUYNH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3853 FOREST PARK AVE APT 116A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3352
Mailing Address - Country:US
Mailing Address - Phone:714-603-5164
Mailing Address - Fax:
Practice Address - Street 1:260 LAMP AND LANTERN VLG
Practice Address - Street 2:
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017-8209
Practice Address - Country:US
Practice Address - Phone:362-203-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019000689122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist