Provider Demographics
NPI:1962526962
Name:JOHNSON, ERIC RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RICHARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:350 LAKESHORE DR W
Mailing Address - Street 2:
Mailing Address - City:LAKE QUIVIRA
Mailing Address - State:KS
Mailing Address - Zip Code:66217-8523
Mailing Address - Country:US
Mailing Address - Phone:913-631-8609
Mailing Address - Fax:913-268-5031
Practice Address - Street 1:315 NICHOLS RD
Practice Address - Street 2:SUITE 208
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1511
Practice Address - Country:US
Practice Address - Phone:816-753-0377
Practice Address - Fax:816-753-3048
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0106771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics