Individual
DR. MATTHEW W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5406
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110607
—
AL
05
—
110617
—
AL
05
—
110619
—
AL
01
—
2105769
UNITED CONCORDIA
—
01
—
510-49384
BLUE CROSS AND BLUE SHIELD
AL
Enumeration date
08/25/2008
Last updated
07/21/2022
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