Provider Demographics
NPI:1912337387
Name:JOHNSON, PAUL RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:JOHNSON
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 1:24331 EL TORO RD 340
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-2754
Mailing Address - Country:US
Mailing Address - Phone:949-656-6313
Mailing Address - Fax:
Practice Address - Street 1:13132 NEWPORT BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:949-491-9973
Practice Address - Fax:714-730-1161
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice