Provider Demographics
NPI:1891856274
Name:JOHNSON, MICHELLE M (DDSMS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6551 STAGE OAKS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3895
Mailing Address - Country:US
Mailing Address - Phone:901-386-5800
Mailing Address - Fax:901-386-9604
Practice Address - Street 1:6551 STAGE OAKS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3895
Practice Address - Country:US
Practice Address - Phone:901-386-5800
Practice Address - Fax:901-386-9604
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000048111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics