Provider Demographics
NPI:1255498788
Name:JOHNSON, DANIEL L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
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 1:1701 AVE E
Mailing Address - Street 2:SUITE D
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2999
Mailing Address - Country:US
Mailing Address - Phone:406-252-4344
Mailing Address - Fax:406-252-4989
Practice Address - Street 1:1701 AVE E
Practice Address - Street 2:SUITE D
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2999
Practice Address - Country:US
Practice Address - Phone:406-252-4344
Practice Address - Fax:406-252-4989
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT1555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0123617Medicaid
MT5510544OtherBLUE CHIP