Provider Demographics
NPI:1114067048
Name:BRYAN C. JOHNSON, DDS, PC
Entity Type:Organization
Organization Name:BRYAN C. JOHNSON, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-432-9531
Mailing Address - Street 1:309 S MAIN ST
Mailing Address - Street 2:P.O. BOX 107
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-1810
Mailing Address - Country:US
Mailing Address - Phone:605-432-9531
Mailing Address - Fax:605-432-4830
Practice Address - Street 1:309 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1810
Practice Address - Country:US
Practice Address - Phone:605-432-9531
Practice Address - Fax:605-432-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM9951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty