Healthcare Provider Details

I. General information

NPI: 1336317833
Provider Name (Legal Business Name): MRS. TONI SMITH-JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W CENTER ST UNITED WAY BUILDING - SUITE 208
ROCHESTER MN
55902-6278
US

IV. Provider business mailing address

903 W CENTER ST UNITED WAY BUILDING - SUITE 208
ROCHESTER MN
55902-6278
US

V. Phone/Fax

Practice location:
  • Phone: 507-529-0435
  • Fax: 507-529-0435
Mailing address:
  • Phone: 507-529-0435
  • Fax: 507-529-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH2647
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: