Provider Demographics
NPI:1003977430
Name:JOHNSON, REBECCA B (DDS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 RAZORBACK DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-2825
Mailing Address - Country:US
Mailing Address - Phone:906-483-0200
Mailing Address - Fax:906-483-0209
Practice Address - Street 1:903 RAZORBACK DR
Practice Address - Street 2:SUITE 10
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-2825
Practice Address - Country:US
Practice Address - Phone:906-483-0200
Practice Address - Fax:906-483-0209
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI169291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice