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Individual
DR. JERRY LEE JOHNSON
Active
Individual
DR. JERRY LEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10185
MN
1223G0001X
General Practice Dentistry
7092
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0964114
DELTA
IA
01
—
10185
DELTA
MN
01
—
176K2JO
BCBS
IA
01
—
46482JO
BCBS
MN
05
—
687623400
—
MN
01
—
820-685
UNITED CONCORDIA
—
Enumeration date
06/28/2006
Last updated
07/08/2007
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