MEDICARE: CHRISTOPHER M JOHNSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D11061	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020998800	OTHER	MN	MN CARE ID

General Provider Information

NPI Number	:	1093704124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER M JOHNSON DDS

Provider Business Mailing Address
First Line	:	10511 E RIVERVIEW DR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-4918
Country	:	US
Telephone Number	:	952-941-9007
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 2ND ST
Second Line	:
City	:	EXCELSIOR
State	:	MN
Zip	:	55331-2038
Country	:	US
Telephone Number	:	952-474-6133
Fax Number	:	952-474-7361

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	11/11/2010

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