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General NPI Number Information
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NPI Number | 1932117553
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Entity Type | Organization
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Legal Business Name | BERNARD J. JOHNSON DDS LLC
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4368 DRESSLER RD NW SUITE 102
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City | CANTON
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State | OH
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Zip | 44718-2771
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Country | US
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Telephone | 330-493-4242
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Fax | 330-493-1303
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Provider Business Mailing Address
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Address Line | 4368 DRESSLER RD NW SUITE 102
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City | CANTON
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State | OH
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Zip | 44718-2771
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Country | US
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Telephone | 330-493-4242
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Fax | 330-493-1303
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BERNARD JOSEPH JOHNSON
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Credential | D.D.S.
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Telephone | 330-493-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 13689
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License Number State | OH
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