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NPI Code Detail

MEDICARE: LARS JOHNSON, DDS, PC

MEDICARE: LARS JOHNSON, DDS, PC
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 Dentistry019026401IL

General Provider Information

NPI Number : 1235406612
Entity Type Code : Organization
Provider Name (Legal Business Name) : LARS JOHNSON, DDS, PC
Provider Business Mailing Address
First Line : 1722 W ALGONQUIN RD
Second Line :
City : HOFFMAN ESTATES
State : IL
Zip : 60192-1573
Country : US
Telephone Number : 847-934-8070
Fax Number : 847-934-0930
Provider Business Practice Location Address
First Line : 1722 W ALGONQUIN RD
Second Line :
City : HOFFMAN ESTATES
State : IL
Zip : 60192-1573
Country : US
Telephone Number : 847-934-8070
Fax Number : 847-934-0930
Authorized Official
Title or Position : OWNER DENTIST
Name : DR. LARS ALAN JOHNSON
Credential : DDS
Telephone Number : 312-388-3289
Provider Enumeration Date : 11/29/2011
Last Update Date : 11/29/2011

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