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General NPI Number Information
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NPI Number | 1568606283
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Entity Type | Organization
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Legal Business Name | DR. WARREN JOHNSON, DDS
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 422 HERITAGE PLACE
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City | FARIBAULT
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State | MN
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Zip | 55021
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Country | US
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Telephone | 507-334-5602
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Fax | 507-334-3488
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Provider Business Mailing Address
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Address Line | 422 HERITAGE PLACE
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City | FARIBAULT
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State | MN
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Zip | 55021
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Country | US
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Telephone | 507-334-5602
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Fax | 507-334-3488
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Authorized Official
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Title or Position | OWNER/PRACTICE
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Name | DR. WARREN D JOHNSON
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Credential | DDS
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Telephone | 507-334-5602
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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 | 7748
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License Number State | MN
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