Individual
MR. RANDY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3053 FREEDOM DR, CHARLOTTE, NC 28208-3859
(704) 393-3911
(704) 392-1096
Mailing address
3053 FREEDOM DR, CHARLOTTE, NC 28208-3859
(704) 393-3911
(704) 392-1096
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
3056
SC
1223G0001X
General Practice Dentistry
Primary
8902
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5910724
—
NC
05
—
Z30565
—
SC
Enumeration date
04/11/2007
Last updated
08/06/2012
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