Provider Demographics
NPI:1730141458
Name:JOHNSON, STEPHEN DRANNEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DRANNEN
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 1:324 W SUPERIOR ST
Mailing Address - Street 2:MEDICAL ARTS BUILDING SUITE 930
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1701
Mailing Address - Country:US
Mailing Address - Phone:218-727-5041
Mailing Address - Fax:218-720-6974
Practice Address - Street 1:324 W SUPERIOR ST
Practice Address - Street 2:MEDICAL ARTS BUILDING SUITE 930
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1701
Practice Address - Country:US
Practice Address - Phone:218-727-5041
Practice Address - Fax:218-720-6974
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND90821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice