Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D5272 | OR |
NPI | 1316979537 |
---|---|
Provider Name | Dennis Allen Johnson |
First Address | Glendale, AZ 85302-4654 |
Second Address | Glendale, AZ 85302-4654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 06/02/2012 |