Organization
BRYAN D. JOHNSON, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN D. JOHNSON DDS (DENTIST)
(507) 243-3747
Entity
Organization
Contact information
Practice address
516 MAIN STREET, MADISON LAKE, MN 56063
(507) 243-3747
(507) 243-3866
Mailing address
PO BOX 458, MADISON LAKE, MN 56063-0458
(507) 243-3747
(507) 243-3866
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9815
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41321JO
BLUE CROSS BLUE SHIELD
MN
Enumeration date
10/11/2005
Last updated
08/22/2020
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