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General NPI Number Information
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NPI Number | 1639236250
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Entity Type | Individual
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Provider Name | MARK O JOHNSON DDS
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3265 SHERIDAN BLVD
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City | LINCOLN
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State | NE
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Zip | 68502-5237
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Country | US
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Telephone | 402-483-2871
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Fax | 402-483-2872
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Provider Business Mailing Address
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Address Line | 4121 S 80TH ST
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City | LINCOLN
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State | NE
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Zip | 68506-5922
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Country | US
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Telephone | 402-770-2976
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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 | 5865
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License Number State | NE
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