# MARQUETTE COUNTY HEALTH DEPARTMENT DENTAL CLINIC

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

## Provider details

- **NPI number:** 1922212901
- **Authorized official:** DR. RANDALL M JOHNSON M.D. (MEDICAL DIRECTOR HEALTH OFFICER)
- **Authorized official phone:** (906) 315-2607

## Contact information

- **Practice address:** 989 W WASHINGTON ST STE 104, MARQUETTE, MI 49855-4073
- **Practice address phone:** (906) 226-9992
- **Mailing address:** 184 US HIGHWAY 41 E, NEGAUNEE, MI 49866
- **Mailing address phone:** (906) 475-9977
- **Mailing address fax:** (906) 475-9312

## Taxonomy

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

## Other

- **Enumeration date:** 05/09/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 88131 | DELTA DENTAL | MI |
| 01 | — | D80157 | BCBS OF MI | MI |