Provider Demographics
NPI:1659375095
Name:JOHNSON, MARSHALL VERNER (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:VERNER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5800 COIT RD
Mailing Address - Street 2:STE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5944
Mailing Address - Country:US
Mailing Address - Phone:972-964-8833
Mailing Address - Fax:972-612-8291
Practice Address - Street 1:5800 COIT RD
Practice Address - Street 2:STE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5944
Practice Address - Country:US
Practice Address - Phone:972-964-8833
Practice Address - Fax:972-612-8291
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15512121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics