Individual
MICHAEL ALLAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
133 TOWNE CENTRE PARKWAY, MYRTLE BEACH, SC 29579-3493
(843) 449-1621
(843) 903-3840
Mailing address
133 TOWNE CENTRE PARKWAY, MYRTLE BEACH, SC 29579-3493
(843) 449-1621
(843) 903-3840
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8911
SC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
958
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8811
DENTAL LICENSE
SC
01
—
958
ORAL & MAXILLOFACIAL SURGERY LICENSE
SC
Enumeration date
03/27/2012
Last updated
11/06/2024
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