Provider Demographics
NPI:1013580554
Name:JOHNSON, MORGAN BLAIR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:BLAIR
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S MAIN ST STE 100B
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949-2211
Mailing Address - Country:US
Mailing Address - Phone:978-777-8722
Mailing Address - Fax:
Practice Address - Street 1:100 S MAIN ST STE 100B
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:MA
Practice Address - Zip Code:01949-2211
Practice Address - Country:US
Practice Address - Phone:978-777-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18590611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice