| Organization Name: | LAWRENCE G JOHANSON DDS, INC. |
| NPI Number: | 1598931974 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAWRENCE GUNNAR JOHANSON (CEO) |
| Mailing Address: | 1661 Pickett Rd Mckinleyville |
| State: | CA US |
| Postal Code: | 955193914 |
| Phone Number: | 7078393227 |
| Fax Number: | 7078390844 |
| NPI Enumeration Date: | 05/05/2008 |
| NPI Last Update Date: | 05/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 18244 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |