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NPI Code Detail

MEDICARE: DAVID ROSS JOHNSON

MEDICARE: DAVID ROSS JOHNSON
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
11223G0001XGeneral Practice Dentistry2901015613MI

General Provider Information

NPI Number : 1194949735
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID ROSS JOHNSON
Provider Business Mailing Address
First Line : 15510 LIVERNOIS AVE
Second Line :
City : DETROIT
State : MI
Zip : 48238-1343
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15510 LIVERNOIS AVE
Second Line :
City : DETROIT
State : MI
Zip : 48238-1343
Country : US
Telephone Number : 313-863-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2007
Last Update Date : 07/08/2007

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Directions to “ DAVID ROSS JOHNSON ” Practice Location

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