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General NPI Number Information
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NPI Number | 1568531861
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Entity Type | Organization
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Legal Business Name | DR. MARK W. JOHNSON, PA
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 604 MCCARTHY BLVD
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City | NEW BERN
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State | NC
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Zip | 28562-5231
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Country | US
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Telephone | 252-638-6177
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Fax | 252-638-5269
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Provider Business Mailing Address
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Address Line | 604 MCCARTHY BLVD
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City | NEW BERN
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State | NC
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Zip | 28562-5231
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Country | US
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Telephone | 252-638-6177
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Fax | 252-638-5269
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. MARK WINTON JOHNSON
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Credential | D.M.D., M.S.
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Telephone | 252-638-6177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 1223S0112X
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License Number State | NC
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