MEDICARE: DR. MAURICE BEN 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	1483	MT

General Provider Information

NPI Number	:	1760507644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURICE BEN JOHNSON DDS

Provider Business Mailing Address
First Line	:	PO BOX 369
Second Line	:
City	:	JOLIET
State	:	MT
Zip	:	59041-0369
Country	:	US
Telephone Number	:	406-962-3190
Fax Number	:

Provider Business Practice Location Address
First Line	:	926 MAIN ST
Second Line	:	SUITE 14
City	:	BILLINGS
State	:	MT
Zip	:	59105-3359
Country	:	US
Telephone Number	:	406-259-0110
Fax Number	:	406-252-0220

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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