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Individual

DR. MATTHEW JEFFREY JOHNSON JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
229 MEDICAL PARK RD STE 300, MOORESVILLE, NC 28117-8544
(704) 360-9995
(704) 360-2221
Mailing address
125 TRADE CT # 26, MOORESVILLE, NC 28117-5545
(704) 360-9995
(704) 360-2221

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2019-02699
NC
208600000X
Surgery Physician
2019-02699
NC
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
05/28/2015
Last updated
04/01/2022
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