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Organization
BRYAN D. JOHNSON, DDS, PA
Active
Organization
BRYAN D. JOHNSON, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN D. JOHNSON DDS (DENTIST)
(507) 243-3747
Entity
Organization
Contact information
Practice address
516 MAIN STREET, MADISON LAKE, MN 56063
(507) 243-3747
(507) 243-3866
Mailing address
PO BOX 458, MADISON LAKE, MN 56063-0458
(507) 243-3747
(507) 243-3866
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9815
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41321JO
BLUE CROSS BLUE SHIELD
MN
Enumeration date
10/11/2005
Last updated
08/22/2020
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