Individual
DR. MARK W. JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5115 COORS BLVD NW STE F, ALBUQUERQUE, NM 87120-1926
(505) 926-5160
(505) 792-4480
Mailing address
5115 COORS BLVD NW STE F, ALBUQUERQUE, NM 87120-1926
(505) 926-5160
(505) 792-4480
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1527
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
841521
UNITED CONCORDIA
—
05
—
85001
—
NM
Enumeration date
08/01/2006
Last updated
11/01/2021
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