Individual
LARRY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
919 W KIRBY AVE, SUITE 4, CHAMPAIGN, IL 61821-5121
(217) 352-9494
(217) 352-7971
Mailing address
PO BOX 3487, CHAMPAIGN, IL 61826-3487
(217) 352-9494
(217) 352-7971
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
03/08/2007
Last updated
07/08/2007
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