Healthcare Provider Details

I. General information

NPI: 1164609384
Provider Name (Legal Business Name): TRUMAN C JOHNSON DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TRUMAN CHRISTOPHER JOHNSON DDS

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 RIVER RIDGE DRIVE NE SUITE A
CEDAR RAPIDS IA
52402-7599
US

IV. Provider business mailing address

3900 RIVER RIDGE DRIVE NE SUITE A
CEDAR RAPIDS IA
52402-7599
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-9880
  • Fax: 319-363-8386
Mailing address:
  • Phone: 319-363-9880
  • Fax: 319-363-8386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7959
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: