Provider Demographics
NPI:1083772289
Name:JOHNSON, MARGARET (DDS)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
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 1:632 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:IL
Mailing Address - Zip Code:61610-3974
Mailing Address - Country:US
Mailing Address - Phone:309-698-0220
Mailing Address - Fax:309-698-0231
Practice Address - Street 1:632 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:IL
Practice Address - Zip Code:61610-3974
Practice Address - Country:US
Practice Address - Phone:309-698-0220
Practice Address - Fax:309-698-0231
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice