Organization
D. TODD JOHNSON DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIA E SAMS (CONTRACT COORDINATOR)
(918) 449-5800
Entity
Organization
Contact information
Practice address
4716 W URBANA ST, BROKEN ARROW, OK 74012-5997
(918) 449-5800
(918) 455-8958
Mailing address
4716 W URBANA ST, BROKEN ARROW, OK 74012-5997
(918) 449-5800
(918) 455-8958
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5019
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100091300A
—
OK
Enumeration date
03/18/2010
Last updated
12/20/2010
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