Individual
JEREMY ROBERT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1006 A ST, GREELEY, CO 80631-2021
(970) 352-0048
(970) 352-1120
Mailing address
2930 11TH AVE, EVANS, CO 80620-1011
(970) 350-4606
(970) 350-4645
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
202438
CO
1223G0001X
General Practice Dentistry
DO816
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99074559
—
CO
Enumeration date
06/25/2008
Last updated
08/10/2015
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