Individual
ROGER GROOM JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1103 NW 67TH, LAWTON, OK 73505
(580) 536-7640
(580) 536-7640
Mailing address
1103 NW 67TH, LAWTON, OK 73505
(580) 536-7640
(580) 536-7640
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
3917
OK
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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