Individual
DAVID BRUCE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1125 W KAGY BLVD STE 303, BOZEMAN, MT 59715-5879
(406) 587-2201
(406) 587-0880
Mailing address
1125 W KAGY BLVD STE 303, BOZEMAN, MT 59715-5879
(406) 587-2201
(406) 587-0880
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1864
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
091-576
UNITED CONCORDIA PROVIDER
—
Enumeration date
12/14/2006
Last updated
02/16/2017
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