Individual
DR. MANTIQUE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
75 MARIETTA ST NW, SUITE 100, ATLANTA, GA 30303-2883
(404) 577-0868
Mailing address
75 MARIETTA ST NW, SUITE 100, ATLANTA, GA 30303-2883
(804) 720-6797
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN013821
GA
Other
Enumeration date
12/12/2008
Last updated
12/12/2008
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