# COYLE & JOHNSON, ORAL & MAXILLOFACIAL SURGERY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285874677
- **Authorized official:** JOHN ANTHONY JOHNSON DDS (OWNER)
- **Authorized official phone:** (573) 449-4900

## Contact information

- **Practice address:** 3015 S PROVIDENCE RD, COLUMBIA, MO 65203-3670
- **Practice address phone:** (573) 449-4900
- **Practice address fax:** (573) 875-6142
- **Mailing address:** 3015 S PROVIDENCE RD, COLUMBIA, MO 65203-3670
- **Mailing address phone:** (573) 449-4900
- **Mailing address fax:** (573) 875-6142

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 02/25/2009
- **Last updated:** 02/25/2009