Johnson, Jeffrey W

Johnson, Jeffrey W is an sole proprietor health care provider with primary practice located at 333 S Woodruff Ave , Idaho Falls ID 83401-4322. He recently has only one registered license in Dental Providers / Orthodontics and Dentofacial Orthopedics, which is considered as his primary health care specialty. Johnson, Jeffrey W can be contacted via phone (208) 529-3500.

Contact Information

Primary practice address
333 S Woodruff Ave Idaho Falls ID 83401-4322
Phone: (208) 529-3500
Fax: (208) 523-9004
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Orthodontics and Dentofacial Orthopedics 1223X0400X D3190OR Idaho
Dental Providers / Orthodontics and Dentofacial Orthopedics 1223X0400X 8041458 Utah

Profile Details

NPI number 1821130253
LBN Legal business name Johnson, Jeffrey W
Credentials DDS, MS
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 13th, 2007
Last updated Jul 20th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821130253 NPPES
Idaho MEDICAID 805176600

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