Healthcare Provider Details

I. General information

NPI: 1700717675
Provider Name (Legal Business Name): GRANT JOHNSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 19TH ST S
BIRMINGHAM AL
35205-4803
US

IV. Provider business mailing address

1025 30TH ST S APT 2B
BIRMINGHAM AL
35205-1126
US

V. Phone/Fax

Practice location:
  • Phone: 205-324-1323
  • Fax:
Mailing address:
  • Phone: 318-348-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD.007621-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: