Healthcare Provider Details

I. General information

NPI: 1811290497
Provider Name (Legal Business Name): BRAD S. JOHNSON, DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 E MORRIS BLVD
MORRISTOWN TN
37813-5729
US

IV. Provider business mailing address

1551 E MORRIS BLVD
MORRISTOWN TN
37813-5729
US

V. Phone/Fax

Practice location:
  • Phone: 423-587-8383
  • Fax: 423-587-8382
Mailing address:
  • Phone: 423-587-8383
  • Fax: 423-587-8382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS8950
License Number StateTN

VIII. Authorized Official

Name: DR. BRAD S JOHNSON
Title or Position: OWNER
Credential: DMD
Phone: 423-587-8383