Organization
BRAD S. JOHNSON, DMD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANICE D HURST (PRACTICE MANAGER)
(423) 587-8383
Entity
Organization
Contact information
Practice address
703 K ST, GREENEVILLE, TN 37745-6246
(423) 639-6769
Mailing address
703 K ST, GREENEVILLE, TN 37745-6246
(423) 639-6769
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS8950
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151-3459
—
TN
Enumeration date
06/03/2013
Last updated
06/03/2013
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