Organization
SOUTH PLAINS PEDIATRIC DENTAL GROUP
Active
Other names
John S Johnson, DDS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN JOHNSON DDS (OWNER)
(806) 687-8080
Entity
Organization
Contact information
Practice address
5102 SALEM AVE, LUBBOCK, TX 79414-4036
(806) 687-8080
(806) 771-6862
Mailing address
5102 SALEM AVE, LUBBOCK, TX 79414-4036
(806) 687-8080
(806) 771-6862
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
17087
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079145101
CSHCN (PROGRAM IN TEXAS FOR DISABLED CHILDREN)
TX
Enumeration date
02/09/2009
Last updated
02/09/2009
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