Organization
SOUTH LOOP DENTAL SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA NICOLE JOHNSON DDS (OWNER)
(713) 398-5329
Entity
Organization
Contact information
Practice address
3577 YELLOWSTONE BLVD, HOUSTON, TX 77021-2440
(713) 398-5329
Mailing address
PO BOX 8144, HOUSTON, TX 77288-8144
(713) 398-5329
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851685697
—
TX
Enumeration date
04/24/2025
Last updated
09/11/2025
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