Provider Demographics
NPI:1881200954
Name:CRIST E. JOHNSON D.D.S, P.C.
Entity Type:Organization
Organization Name:CRIST E. JOHNSON D.D.S, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRIST
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-527-3460
Mailing Address - Street 1:330 LOVELL ST
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-9706
Mailing Address - Country:US
Mailing Address - Phone:616-527-3460
Mailing Address - Fax:616-527-6349
Practice Address - Street 1:330 LOVELL ST
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-9706
Practice Address - Country:US
Practice Address - Phone:616-527-3460
Practice Address - Fax:616-527-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental