Provider Demographics
NPI:1144580358
Name:JOHNSON, BARTHOLOMEW PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:BARTHOLOMEW
Middle Name:PAUL
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 1:401 JEWETT ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2605
Mailing Address - Country:US
Mailing Address - Phone:507-532-3104
Mailing Address - Fax:507-537-1347
Practice Address - Street 1:401 JEWETT ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2605
Practice Address - Country:US
Practice Address - Phone:507-532-3104
Practice Address - Fax:507-537-1347
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND130901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice