Provider Demographics
NPI:1760507644
Name:JOHNSON, MAURICE BEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:BEN
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:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:MT
Mailing Address - Zip Code:59041-0369
Mailing Address - Country:US
Mailing Address - Phone:406-962-3190
Mailing Address - Fax:
Practice Address - Street 1:926 MAIN ST
Practice Address - Street 2:SUITE 14
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-3359
Practice Address - Country:US
Practice Address - Phone:406-259-0110
Practice Address - Fax:406-252-0220
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT14831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice