Individual
DR. JACOB LYNN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
BLDG 1200, 149G W HART ST, SHEPPARD AFB, TX 76311-7631
(940) 676-4412
Mailing address
5021 TAFT BLVD APT 3302, WICHITA FALLS, TX 76308-5391
(701) 339-1678
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2017020610
MO
1223G0001X
General Practice Dentistry
34858
TX
171000000X
Military Health Care Provider
Primary
34858
TX
Other
Enumeration date
08/22/2017
Last updated
08/20/2023
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