Individual
RYAN DANIEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2525 W ILES AVE, SPRINGFIELD, IL 62704-4283
(217) 787-7744
(217) 793-3620
Mailing address
2525 W ILES AVE, SPRINGFIELD, IL 62704-4283
(217) 787-7744
(217) 793-3620
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.028015
IL
Other
Enumeration date
07/21/2009
Last updated
11/28/2012
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