Individual
DR. BLAKE BRUCE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3705 N MAIN ST STE 200, TAYLOR, TX 76574-4997
(512) 595-7439
Mailing address
3705 N MAIN ST STE 200, TAYLOR, TX 76574-4997
(512) 595-7439
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
39651
TX
1223G0001X
General Practice Dentistry
39651
TX
Other
Enumeration date
06/14/2023
Last updated
06/28/2023
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