Individual
NEAL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
115 W 100 S, RUPERT, ID 83350-9125
(208) 436-4532
(208) 436-0347
Mailing address
115 W 100 S, RUPERT, ID 83350-9125
(208) 436-4532
(208) 436-0347
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3903
ID
Other
Enumeration date
08/08/2006
Last updated
07/08/2007
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