Healthcare Provider Details

I. General information

NPI: 1932117553
Provider Name (Legal Business Name): BERNARD J. JOHNSON DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 DRESSLER RD NW SUITE 102
CANTON OH
44718-2771
US

IV. Provider business mailing address

4368 DRESSLER RD NW SUITE 102
CANTON OH
44718-2771
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-4242
  • Fax: 330-493-1303
Mailing address:
  • Phone: 330-493-4242
  • Fax: 330-493-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number13689
License Number StateOH

VIII. Authorized Official

Name: DR. BERNARD JOSEPH JOHNSON
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 330-493-4242