Provider Demographics
NPI:1073777389
Name:JOHNSON, JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
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 1:825 28 ST SW
Mailing Address - Street 2:SUITE F
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3702
Mailing Address - Country:US
Mailing Address - Phone:701-237-4297
Mailing Address - Fax:701-237-2223
Practice Address - Street 1:825 28 ST SW
Practice Address - Street 2:SUITE F
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3702
Practice Address - Country:US
Practice Address - Phone:701-237-4297
Practice Address - Fax:701-237-2223
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist