Provider Demographics
NPI:1003300989
Name:JOHNSON, TIMOTHY CHAPMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHAPMAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-2119
Mailing Address - Country:US
Mailing Address - Phone:406-883-0496
Mailing Address - Fax:
Practice Address - Street 1:203 MAIN ST
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2119
Practice Address - Country:US
Practice Address - Phone:406-883-0496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-15423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist