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Individual
MICHAEL ALLAN JOHNSON
Active
Individual
MICHAEL ALLAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8911
SC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
958
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8811
DENTAL LICENSE
SC
01
—
958
ORAL & MAXILLOFACIAL SURGERY LICENSE
SC
Enumeration date
03/27/2012
Last updated
11/06/2024
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