Organization
JOHNSON FAMILY DENTAL CARE LLC
Active
Other names
Johnson Family Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL D JOHNSON DDS (OWNER)
(507) 532-3104
Entity
Organization
Contact information
Practice address
401 JEWETT ST, MARSHALL, MN 56258-2605
(507) 532-3104
(507) 537-1347
Mailing address
401 JEWETT ST, MARSHALL, MN 56258-2605
(507) 532-3104
(507) 537-1347
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128218200
MINNESOTA MEDICAL ASSISTANCE
—
01
—
46120JO
BLUE CROSS BLUE SHIELD
—
01
—
810572
UNITED CONCORDIA
—
Enumeration date
01/10/2012
Last updated
03/14/2024
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