Individual
DR. CORY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
170 E COMMONWEALTH AVE, SOUTH SALT LAKE, UT 84115-2712
(719) 660-8188
Mailing address
170 E COMMONWEALTH AVE, SOUTH SALT LAKE, UT 84115-2712
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
11774185-0702
UT
122300000X
Dentist
Primary
11774185-9922
UT
Other
Enumeration date
06/01/2020
Last updated
07/24/2020
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