Individual
DR. J TERRY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
427 E KANESVILLE BLVD, SUITE 306, COUNCIL BLUFFS, IA 51503-4403
(712) 328-1885
Mailing address
427 E KANESVILLE BLVD, SUITE 306, COUNCIL BLUFFS, IA 51503-4403
(712) 328-1885
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5907
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0119693
—
IA
Enumeration date
02/17/2006
Last updated
07/09/2007
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