Individual
MARK W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
487 N MAIN, SUITE B, THAYNE, WY 83127
(307) 883-4222
(307) 883-4223
Mailing address
PO BOX 1365, THAYNE, WY 83127-1365
(307) 883-4222
(307) 883-4223
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1130
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124642900
—
WY
Enumeration date
01/18/2007
Last updated
07/30/2014
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