Individual
JOEL MICAH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10211 DUPONT CIRCLE DR W STE A, FORT WAYNE, IN 46825-1625
(260) 489-8989
(734) 763-8100
Mailing address
10211 DUPONT CIRCLE DR W STE A, FORT WAYNE, IN 46825-1625
(260) 489-8989
(734) 763-8100
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
2901020824
MI
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12011754A
IN
Other
Enumeration date
10/15/2012
Last updated
10/07/2014
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