Individual
DR. JOHN BERNARD JOHNSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6215 CENTRAL AVE, PORTAGE, IN 46368-3725
(219) 763-1502
(219) 762-3100
Mailing address
6215 CENTRAL AVE, PORTAGE, IN 46368-3725
(219) 763-1502
(219) 762-3100
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12007783A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12007783A
STATE LICENCE
IN
Enumeration date
02/11/2007
Last updated
07/08/2007
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