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General NPI Number Information
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NPI Number | 1285696708
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Entity Type | Individual
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Provider Name | LYNN MICHAEL JOHNSON DDS
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Gender | Male
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 2050 2ND ST SE
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City | KIRTLAND AFB
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State | NM
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Zip | 87117-5524
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Country | US
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Telephone | 505-846-2466
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Fax |
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Provider Business Mailing Address
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Address Line | 11217 WOODMAR LN NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-6510
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Country | US
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Telephone | 505-291-1437
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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 | 105419
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License Number State | CO
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