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General NPI Number Information
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NPI Number | 1801022934
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Entity Type | Organization
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Legal Business Name | MARK D. JOHNSON D.D.S., P.S.
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 6927 LAKEWOOD DR W STE C2
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City | TACOMA
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State | WA
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Zip | 98467-3247
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Country | US
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Telephone | 253-565-1695
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Fax | 253-565-1588
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Provider Business Mailing Address
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Address Line | 6927 LAKEWOOD DR W STE C2
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City | TACOMA
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State | WA
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Zip | 98467-3247
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Country | US
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Telephone | 253-565-1695
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Fax | 253-565-1588
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MARK DOUGLAS JOHNSON
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Credential | DDS
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Telephone | 253-565-1695
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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 | DE60096175
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE00005841
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License Number State | WA
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