Individual
JOHNSON C MIIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MSE
Contact information
Practice address
1351 MAIN ST, BROCKTON, MA 02301-7153
(508) 587-2000
(508) 597-3552
Mailing address
1351 MAIN ST, BROCKTON, MA 02301-7153
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8512
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN1856466
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
MS
Other
Enumeration date
07/09/2008
Last updated
10/15/2014
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