Individual
COLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2017 S WESTERN AVE, MARION, IN 46953-2824
(317) 910-2089
Mailing address
2234 WOODCREEK DR, AVON, IN 46123-8096
(317) 910-2089
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12013639A
IN
Other
Enumeration date
06/18/2021
Last updated
06/18/2021
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