Provider Demographics
NPI:1477801298
Name:MICHAEL D. JOHNSON, D.D.S.,P.C.
Entity Type:Organization
Organization Name:MICHAEL D. JOHNSON, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-741-6217
Mailing Address - Street 1:2090 LARKIN AVE
Mailing Address - Street 2:UNIT ONE-REAR
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5845
Mailing Address - Country:US
Mailing Address - Phone:847-741-6217
Mailing Address - Fax:847-741-6217
Practice Address - Street 1:2090 LARKIN AVE
Practice Address - Street 2:UNIT ONE-REAR
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5845
Practice Address - Country:US
Practice Address - Phone:847-741-6217
Practice Address - Fax:847-741-6217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.020007261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental