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General NPI Number Information
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NPI Number | 1073821286
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Entity Type | Individual
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Provider Name | BENJAMIN REED JOHNSON D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 601 S CARR RD SUITE 300
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City | RENTON
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State | WA
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Zip | 98055-5866
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Country | US
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Telephone | 425-466-1185
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S CARR RD SUITE 300
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City | RENTON
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State | WA
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Zip | 98055-5866
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Country | US
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Telephone | 425-466-1185
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.028413
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 60204550
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License Number State | WA
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