Individual
MICHAEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., MSD
Contact information
Practice address
5429 BOULDER DR, WEST DES MOINES, IA 50266-7260
(515) 715-0153
Mailing address
5429 BOULDER DR, WEST DES MOINES, IA 50266-7260
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DDS-09356
IA
Other
Enumeration date
05/03/2017
Last updated
05/03/2017
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