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General NPI Number Information
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NPI Number | 1124375423
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Entity Type | Individual
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Provider Name | GLEN HOWARD JOHNSON DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | UNIVERSITY OF WASHINGTON SCHOOL OF DENTISTRY RESTORATIVE DENTISTRY BOX 357456
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City | SEATTLE
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State | WA
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Zip | 98195-0001
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Country | US
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Telephone | 206-543-5948
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Fax | 206-543-7783
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Provider Business Mailing Address
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Address Line | BOX 357456, DEPARTMENT OF RESTORATIVE DENTISTRY UNIVERSITY OF WASHINGTON
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City | SEATTLE
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State | WA
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Zip | 98195-7456
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Country | US
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Telephone | 206-543-5948
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Fax | 206-543-7783
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 5146
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License Number State | WA
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