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General NPI Number Information
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NPI Number | 1922290345
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Entity Type | Individual
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Provider Name | ABBY PERSHKE JOHNSON DDS
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Gender | Female
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4419 AIR BASE RD
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City | HERMANTOWN
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State | MN
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Zip | 55811-1847
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Country | US
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Telephone | 218-728-2117
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Fax | 218-728-2700
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Provider Business Mailing Address
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Address Line | 4419 AIR BASE RD
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City | HERMANTOWN
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State | MN
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Zip | 55811
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Country | US
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Telephone | 218-728-2117
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Fax | 218-728-2700
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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 | D12426
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10033
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D12426
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License Number State | MN
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