Individual
DR. LARRY A JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
69 HALL ROAD, STURBRIDGE, MA 07566
(508) 347-2673
(508) 847-5085
Mailing address
69 HALL ROAD, STURBRIDGE, MA 07566
(508) 347-2673
(508) 847-5085
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
006125
CT
1223P0300X
Periodontics
Primary
12356
MA
Other
Enumeration date
09/30/2008
Last updated
09/30/2008
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