Individual
CRAIG BRIAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
25579 CHURCH ST, NISSWA, MN 56468
(218) 963-2970
(218) 963-9502
Mailing address
PO BOX 157, NISSWA, MN 56468
(218) 963-2970
(218) 963-9502
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1003
WY
122300000X
Dentist
Primary
D11320
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7479785
MINNESOTA STATE TAX
—
Enumeration date
09/25/2006
Last updated
07/08/2007
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