Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 1351 | MT |
NPI | 1679593974 |
---|---|
Provider Name | Dr. Michael D Johnson |
First Address | Helena, MT 59601-4759 |
Second Address | Helena, MT 59601-4759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40964 | BLUE CROSS BLUE SHIELD (01) | MT |
5511571 | CHIPS (01) | MT |
730106 | (05) | MT |
9988329 | CHAMPUS (01) | MT |