# JOHNSON FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** johnson family dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073124103
- **Authorized official:** STACIA GRZIBOWSKI (OFFICE MANAGER)
- **Authorized official phone:** (269) 381-7250

## Contact information

- **Practice address:** 1617 E MILHAM AVE, PORTAGE, MI 49002-3049
- **Practice address phone:** (269) 381-7250
- **Practice address fax:** (269) 381-7260
- **Mailing address:** 1617 E MILHAM AVE, PORTAGE, MI 49002-3049
- **Mailing address phone:** (269) 381-7250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/12/2020
- **Last updated:** 08/12/2020