Individual
GREGORY JUSTIN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 3RD AVE W, RICHARDTON, ND 58652-0333
(701) 974-2118
(701) 974-2175
Mailing address
200 3RD AVE W, RICHARDTON, ND 58652-0333
(701) 974-2118
(701) 974-2175
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1720
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40988
—
ND
Enumeration date
11/22/2005
Last updated
05/04/2017
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