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General NPI Number Information
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NPI Number | 1902032063
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Entity Type | Organization
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Legal Business Name | MARK A. JOHNSON DDS PS
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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 | 601 SE 117TH AVE STE 200
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City | VANCOUVER
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State | WA
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Zip | 98683-5297
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Country | US
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Telephone | 360-254-1590
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Fax | 360-254-1939
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Provider Business Mailing Address
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Address Line | 601 SE 117TH AVE STE 200
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City | VANCOUVER
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State | WA
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Zip | 98683-5297
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Country | US
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Telephone | 360-254-1590
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Fax | 360-254-1939
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK A JOHNSON
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Credential | DDS
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Telephone | 360-254-1590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6095
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License Number State | WA
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