Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 3966 | OK |
NPI | 1043372907 |
---|---|
Provider Name | Howard Goss Johnson III |
First Address | Oklahoma City, OK 73118-2058 |
Second Address | Oklahoma City, OK 73118-2058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 08/07/2007 |