Organization
FUSION DENTAL AT CLEAR CREEK PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNY W JOHNSON (OWNER/DENTIST)
(254) 213-5773
Entity
Organization
Contact information
Practice address
4102 S CLEAR CREEK RD STE 102, KILLEEN, TX 76549-5954
(254) 213-5773
Mailing address
4102 S CLEAR CREEK RD STE 102, KILLEEN, TX 76549-5954
(254) 213-5773
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
25786
TX
Other
Enumeration date
05/13/2014
Last updated
09/23/2014
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