Individual
DR. MARK ROBIN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
114 ALTAMA CONNECTOR, BRUNSWICK, GA 31525-1891
(912) 262-6688
(912) 264-2409
Mailing address
114 ALTAMA CONNECTOR, BRUNSWICK, GA 31535
(912) 262-6688
(912) 264-2409
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN013620
GA
1223G0001X
General Practice Dentistry
12008101
IN
1223G0001X
General Practice Dentistry
Primary
DN013620
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
422264878
—
GA
Enumeration date
12/15/2006
Last updated
11/28/2012
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