Healthcare Provider Details

I. General information

NPI: 1679593974
Provider Name (Legal Business Name): MICHAEL D JOHNSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 9TH AVE
HELENA MT
59601-4759
US

IV. Provider business mailing address

1930 9TH AVE
HELENA MT
59601-4759
US

V. Phone/Fax

Practice location:
  • Phone: 406-457-8928
  • Fax: 406-457-8992
Mailing address:
  • Phone: 406-457-8928
  • Fax: 406-457-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number1351
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: