Individual
DR. MARY BETH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
HWY 264, MP 388, POLACCA, AZ 86042
(928) 737-6162
Mailing address
HOPI HEALTH CARE CENTER KEAMS CANYON S.U., PO BOX 4000, POLACCA, AZ 86042
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30020478
OH
1223P0221X
Pediatric Dentistry
30-020478
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420456
—
AZ
Enumeration date
02/15/2007
Last updated
06/26/2009
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