Individual
ABBY PERSHKE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4419 AIR BASE RD, HERMANTOWN, MN 55811-1847
(218) 728-2117
(218) 728-2700
Mailing address
4419 AIR BASE RD, HERMANTOWN, MN 55811
(218) 728-2117
(218) 728-2700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D12426
MN
1223P0221X
Pediatric Dentistry
10033
TN
1223P0221X
Pediatric Dentistry
Primary
D12426
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10033
LICENSE
TN
01
—
D12426
LICENSE
MN
Enumeration date
08/10/2007
Last updated
07/21/2022
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