Individual
TERESA EVELYN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MS, MPH, FASGD
Contact information
Practice address
115 DREW AVE SE, MADELIA, MN 56062-1841
(507) 642-8742
(507) 642-2926
Mailing address
115 DREW AVE SE, MADELIA, MN 56062-1841
(507) 642-8742
(507) 642-2926
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10071
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
503822700
—
MN
Enumeration date
12/13/2006
Last updated
02/22/2012
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