Healthcare Provider Details

I. General information

NPI: 1700869591
Provider Name (Legal Business Name): DONALD ALLEN JOHNSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6945 PENN AVE S
RICHFIELD MN
55423
US

IV. Provider business mailing address

10234 QUEEN AVE S
BLOOMINGTON MN
55431
US

V. Phone/Fax

Practice location:
  • Phone: 612-866-2233
  • Fax:
Mailing address:
  • Phone: 952-888-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7920
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: