Organization
MINNIE STREET CHILDREN'S DENTISTRY, PC
Active
Other names
Rising Stars Children's Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY L JOHNSON DDS (MEMBER)
(907) 479-8844
Entity
Organization
Contact information
Practice address
114 MINNIE ST STE B, FAIRBANKS, AK 99701-3000
(907) 308-2200
Mailing address
114 MINNIE ST STE B, FAIRBANKS, AK 99701-3000
(907) 308-2200
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UNKNOWN
UNKNOWN
AK
Enumeration date
08/24/2021
Last updated
08/24/2021
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