Individual
JARED C JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1706 OVERLAND AVE, BURLEY, ID 83318-2436
(208) 678-2332
(208) 677-8922
Mailing address
1706 OVERLAND AVE, BURLEY, ID 83318-2436
(208) 678-2332
(208) 677-8922
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-2079
ID
Other
Enumeration date
03/14/2007
Last updated
07/09/2007
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