Provider Demographics
NPI:1619397874
Name:BRET M. JOHNSON DDS MS PS
Entity Type:Organization
Organization Name:BRET M. JOHNSON DDS MS PS
Other - Org Name:BRET JOHNSON ORTHODOTNICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-466-2666
Mailing Address - Street 1:755 E HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-5000
Mailing Address - Country:US
Mailing Address - Phone:509-466-2666
Mailing Address - Fax:
Practice Address - Street 1:755 E HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-5000
Practice Address - Country:US
Practice Address - Phone:509-466-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty