Healthcare Provider Details

I. General information

NPI: 1073777389
Provider Name (Legal Business Name): JAMES JOHNSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 28 ST SW SUITE F
FARGO ND
58103-3702
US

IV. Provider business mailing address

825 28 ST SW SUITE F
FARGO ND
58103-3702
US

V. Phone/Fax

Practice location:
  • Phone: 701-237-4297
  • Fax: 701-237-2223
Mailing address:
  • Phone: 701-237-4297
  • Fax: 701-237-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2022
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: