Individual
DR. JOHN A JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
420 N DIVISION ST., CRAIGMONT, ID 83523
(208) 924-5830
(208) 924-7516
Mailing address
420 N. DIVISION ST., P.O. BOX 188, CRAIGMONT, ID 83523
(208) 924-5830
(208) 924-7516
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1388
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017744400
—
ID
01
—
1000932
REGENCE BLUE SHIELD
ID
01
—
6201-8
BLUE CROSS
ID
01
—
836142
UNITED CONCORDIA TDP
ID
Enumeration date
05/22/2006
Last updated
07/08/2007
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