Provider Demographics
NPI:1033745120
Name:DIAZ JOHNSON, JEIMY YSABEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JEIMY
Middle Name:YSABEL
Last Name:DIAZ JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 NE RICE RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-6788
Mailing Address - Country:US
Mailing Address - Phone:816-477-7070
Mailing Address - Fax:
Practice Address - Street 1:1153 NE RICE RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6788
Practice Address - Country:US
Practice Address - Phone:816-477-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210358921223G0001X
FLDN249881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice