Provider Demographics
NPI:1831138114
Name:JOHNSON, JOY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 RAINBOW DR NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4908
Mailing Address - Country:US
Mailing Address - Phone:763-586-0036
Mailing Address - Fax:651-653-9923
Practice Address - Street 1:4100 BELLAIRE AVE
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3910
Practice Address - Country:US
Practice Address - Phone:651-426-0038
Practice Address - Fax:651-653-9923
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice