Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | OMS36 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | A73900 | CA |
NPI | 1508913021 |
---|---|
Provider Name | Dr. Arthur Johnson III |
First Address | Laguna Niguel, CA 92607-7440 |
Second Address | Laguna Niguel, CA 92677-1222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 17/03/2018 |