Individual
DR. GARY ROBERT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5646 SAINT CHARLES RD, SUITE C, BERKELEY, IL 60163-1148
(708) 544-7474
Mailing address
5646 SAINT CHARLES RD, SUITE C, BERKELEY, IL 60163-1148
(708) 544-7474
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019017208
IL
1223G0001X
General Practice Dentistry
319006856
IL
Other
Enumeration date
07/27/2006
Last updated
10/26/2015
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