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General NPI Number Information
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NPI Number | 1033247432
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Entity Type | Individual
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Provider Name | MARY ELIZABETH JOHNSON D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6545 FRANCE AVE S SUITE 665
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City | EDINA
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State | MN
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Zip | 55435-2131
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Country | US
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Telephone | 952-927-8694
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Fax | 952-927-8695
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Provider Business Mailing Address
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Address Line | 6545 FRANCE AVE S SUITE 665
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City | EDINA
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State | MN
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Zip | 55435-2131
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Country | US
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Telephone | 952-927-8694
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Fax | 952-927-8695
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D9559
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License Number State | MN
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