Individual
JESSE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1137 COMMERCIAL DR SE, RIO RANCHO, NM 87124-4658
(505) 896-9399
Mailing address
9201 EAGLE RANCH RD NW, ALBUQUERQUE, NM 87114
(505) 553-3607
(505) 890-2949
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD4776
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000
—
NM
Enumeration date
08/09/2017
Last updated
10/08/2024
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