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General NPI Number Information
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NPI Number | 1912289885
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Entity Type | Individual
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Provider Name | RODNEY CORDELL JOHNS DMD
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Gender | Male
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 2818 S 25TH E
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6509
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Country | US
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Telephone | 208-243-8391
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 W 25 N
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City | CLEARFIELD
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State | UT
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Zip | 84015-8621
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Country | US
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Telephone | 801-603-5719
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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 | 3082668-9922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D-55577
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License Number State | ID
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