Organization
CANTON COMMUNITYDENTALCLINICLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY TERELL JOHNSON DDS (DENTIST)
(601) 855-5885
Entity
Organization
Contact information
Practice address
512 W FULTON ST, CANTON, MS 39046-4254
(601) 855-5885
(601) 855-2833
Mailing address
512 W FULTON ST, CANTON, MS 39046-4254
(601) 855-5885
(601) 855-2833
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3108-99
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08324092
—
MS
Enumeration date
09/14/2006
Last updated
08/22/2020
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