Individual
DR. MICHAEL C JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
540 LAKE ST # 1000, EXCELSIOR, MN 55331-1903
(801) 471-8311
Mailing address
540 LAKE ST # 1000, EXCELSIOR, MN 55331-1903
(801) 471-8311
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D14501
MN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DE60642383
WA
Other
Enumeration date
08/10/2012
Last updated
03/11/2021
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