Provider Demographics
NPI:1124375423
Name:JOHNSON, GLEN HOWARD (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:HOWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 357456, DEPARTMENT OF RESTORATIVE DENTISTRY
Mailing Address - Street 2:UNIVERSITY OF WASHINGTON
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-7456
Mailing Address - Country:US
Mailing Address - Phone:206-543-5948
Mailing Address - Fax:206-543-7783
Practice Address - Street 1:UNIVERSITY OF WASHINGTON SCHOOL OF DENTISTRY
Practice Address - Street 2:RESTORATIVE DENTISTRY BOX 357456
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-5948
Practice Address - Fax:206-543-7783
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist