Individual
JENNA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MDT
Contact information
Practice address
1790 7TH ST E, SAINT PAUL, MN 55119
(651) 735-0521
Mailing address
8718 QUARRY RIDGE LN, UNIT D, WOODBURY, MN 55125-7523
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
DT80
MN
Other
Enumeration date
04/06/2017
Last updated
05/30/2018
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