Individual
DR. CHARLES CHAD JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2907 E JOYCE BLVD, SUITE 12, FAYETTEVILLE, AR 72703-5011
(479) 445-6688
Mailing address
2907 E JOYCE BLVD, SUITE 12, FAYETTEVILLE, AR 72703-5011
(479) 445-6688
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AR3377
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1397170
UNITED CONCORDIA NUMER
PA
01
—
5X003
BLUE CROSS PROVIDER NUMBE
AR
Enumeration date
07/27/2006
Last updated
07/29/2014
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