=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851439392
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL COREY JOHNSON DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2007
-----------------------------------------------------
Last Update Date | 05/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 US HIGHWAY 46 B 15
-----------------------------------------------------
City | MOUNTAIN LAKES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07046-1668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-402-8111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 COLD HILL RD. SOUTH 8
-----------------------------------------------------
City | MENDHAM
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-543-4828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 15749
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------