Provider Demographics
NPI:1346488772
Name:JOHNSON, CHRISTIAN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:T
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 1:105 SE FRONTIER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CEDAREDGE
Mailing Address - State:CO
Mailing Address - Zip Code:81413-4020
Mailing Address - Country:US
Mailing Address - Phone:970-856-3010
Mailing Address - Fax:970-856-3080
Practice Address - Street 1:105 SE FRONTIER AVE STE B
Practice Address - Street 2:
Practice Address - City:CEDAREDGE
Practice Address - State:CO
Practice Address - Zip Code:81413-4020
Practice Address - Country:US
Practice Address - Phone:970-856-3010
Practice Address - Fax:970-856-3080
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice