Individual
DR. MARK A JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
217 MOORE RD, KING, NC 27021-8703
(336) 983-5095
(336) 983-5738
Mailing address
113 OAKDALE CIR, KING, NC 27021-7842
(336) 983-5916
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5087
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8994644
—
NC
01
—
94644
BLUE CROSS PROVIDER #
NC
Enumeration date
01/06/2006
Last updated
07/09/2007
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