Individual
MICHAEL B JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
815 E 6TH ST, TISHOMINGO, OK 73460-2847
(580) 421-4570
(580) 421-6283
Mailing address
1001 N COUNTRY CLUB RD, ADA, OK 74820-2847
(580) 421-4570
(580) 421-6283
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11189
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11189
—
TX
Enumeration date
06/06/2007
Last updated
05/28/2008
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