# MARK W JOHNSON, DMD, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Riverside Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073204533
- **Authorized official:** DR. MARK JOHNSON DMD (DENTIST)
- **Authorized official phone:** (307) 883-4222

## Contact information

- **Practice address:** 487 N MAIN ST STE B, THAYNE, WY 83127-9768
- **Practice address phone:** (307) 883-4222
- **Mailing address:** 487 N MAIN ST STE B, THAYNE, WY 83127-9768
- **Mailing address phone:** (307) 883-4222

## Taxonomy

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

## Other

- **Enumeration date:** 05/16/2023
- **Last updated:** 05/16/2023