Provider Demographics
NPI:1164609384
Name:JOHNSON, TRUMAN C (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TRUMAN
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:TRUMAN
Other - Middle Name:CHRISTOPHER
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3900 RIVER RIDGE DRIVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7599
Mailing Address - Country:US
Mailing Address - Phone:319-363-9880
Mailing Address - Fax:319-363-8386
Practice Address - Street 1:3900 RIVER RIDGE DRIVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7599
Practice Address - Country:US
Practice Address - Phone:319-363-9880
Practice Address - Fax:319-363-8386
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA79591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics