Provider Demographics
NPI:1558341685
Name:JOHNSON, DANIEL JOHN
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:J
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:12432 HOWLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6910
Mailing Address - Country:US
Mailing Address - Phone:734-453-8953
Mailing Address - Fax:
Practice Address - Street 1:37668 FORD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1924
Practice Address - Country:US
Practice Address - Phone:734-729-2366
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist