Provider Demographics
NPI:1750403192
Name:JOHNSON, STEVEN B (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E 58TH ST RM 1204
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1261
Mailing Address - Country:US
Mailing Address - Phone:212-223-1220
Mailing Address - Fax:212-223-0943
Practice Address - Street 1:133 E 58TH ST RM 1204
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1261
Practice Address - Country:US
Practice Address - Phone:212-223-1220
Practice Address - Fax:212-223-0943
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0370961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice