Individual
JEREMY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1100 19TH AVE SW, SUITE 1, WILLMAR, MN 56201-5288
(320) 325-3102
Mailing address
1100 19TH AVE SW, SUITE 1, WILLMAR, MN 56201-5288
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D11637
MN
Other
Enumeration date
04/12/2007
Last updated
04/14/2022
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