Individual
DR. MATTHEW W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7200 HALCYON SUMMIT DRIVE, MONTGOMERY, AL 36117-7047
(334) 277-3492
(334) 277-9432
Mailing address
7200 HALCYON SUMMIT DRIVE, MONTGOMERY, AL 36117-7047
(334) 277-3492
(334) 277-9432
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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