Individual
JOSEPH WONG JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8417 W 101ST STREET CIR, BLOOMINGTON, MN 55438-1914
(612) 387-2277
Mailing address
8417 W 101ST STREET CIR, BLOOMINGTON, MN 55438-1914
(612) 387-2277
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D13080
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2012
Last updated
05/24/2012
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