MEDICARE: DR. JOY M JOHNSON D.D.S.

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	11443	MN

General Provider Information

NPI Number	:	1831138114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOY M JOHNSON D.D.S.

Provider Business Mailing Address
First Line	:	6121 RAINBOW DR NE
Second Line	:
City	:	FRIDLEY
State	:	MN
Zip	:	55432-4908
Country	:	US
Telephone Number	:	763-586-0036
Fax Number	:	651-653-9923

Provider Business Practice Location Address
First Line	:	4100 BELLAIRE AVE
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-3910
Country	:	US
Telephone Number	:	651-426-0038
Fax Number	:	651-653-9923

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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