Individual
DR. MARY ANN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
320 COMANCHE ST., KIOWA, CO 80117
(720) 389-9763
Mailing address
3205 N ACADEMY BLVD, SUITE 130, COLORADO SPRINGS, CO 80917-5147
(719) 632-5700
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DEN.00202717
CO
122300000X
Dentist
DN011093
GA
1223G0001X
General Practice Dentistry
Primary
DEN.00202717
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80200079
—
CO
Enumeration date
10/02/2015
Last updated
04/04/2017
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