Individual
DR. JEFFREY W JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
333 S WOODRUFF AVE, IDAHO FALLS, ID 83401-4322
(208) 529-3500
(208) 523-9004
Mailing address
333 S WOODRUFF AVE, IDAHO FALLS, ID 83401-4322
(208) 529-3500
(208) 523-9004
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
8041458
UT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D3190OR
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805176600
—
ID
Enumeration date
02/13/2007
Last updated
07/20/2011
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