Healthcare Provider Details

I. General information

NPI: 1750651527
Provider Name (Legal Business Name): JOHNSON FAMILY DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 JEWETT ST
MARSHALL MN
56258-2605
US

IV. Provider business mailing address

401 JEWETT ST
MARSHALL MN
56258-2605
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-3104
  • Fax: 507-537-1347
Mailing address:
  • Phone: 507-532-3104
  • Fax: 507-537-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: BARTHOLOMEW PAUL JOHNSON
Title or Position: OWNER
Credential: DDS
Phone: 507-401-1870