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General NPI Number Information
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NPI Number | 1932301454
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Entity Type | Organization
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Legal Business Name | MICHAEL L. JOHNSON DDS P.C.
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6812 E BROWN RD STE 102
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City | MESA
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State | AZ
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Zip | 85207-3757
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Country | US
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Telephone | 480-981-8560
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Fax |
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Provider Business Mailing Address
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Address Line | 6812 E BROWN RD #102
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City | MESA
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State | AZ
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Zip | 85207-3757
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Country | US
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Telephone | 480-981-8560
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MICHAEL L. JOHNSON
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Credential | DDS P.C.
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Telephone | 480-981-8560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3290
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License Number State | AZ
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