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Organization
JOHNSON FAMILY DENTAL CARE LLC
Active
Organization
JOHNSON FAMILY DENTAL CARE LLC
Active
Other names
Marshall Airway Center, Johnson Family Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
BARTHOLOMEW PAUL JOHNSON DDS (OWNER)
(507) 401-1870
Entity
Organization
Contact information
Practice address
401 JEWETT ST, MARSHALL, MN 56258-2605
(507) 532-3104
(507) 537-1347
Mailing address
401 JEWETT ST, MARSHALL, MN 56258-2605
(507) 532-3104
(507) 537-1347
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128218200
MINNESOTA MEDICAL ASSISTANCE
—
01
—
46120JO
BLUE CROSS BLUE SHIELD
—
01
—
810572
UNITED CONCORDIA
—
Enumeration date
01/10/2012
Last updated
08/10/2026
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