Individual
DR. BRYAN J JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4250 PONTIAC LAKE RD, SUITE B, WATERFORD, MI 48328-1281
(248) 674-0303
(248) 674-2947
Mailing address
11525 HIGHLAND RD, SUITE 23, HARTLAND, MI 48353-2726
(810) 632-0303
(810) 632-7305
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
BJ017615
MI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
BJ017615
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190F37120
BCBS OF MI
MI
Enumeration date
09/08/2006
Last updated
06/27/2014
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