Provider Demographics
NPI:1992844799
Name:JOHNSON, STEPHEN P (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
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 1:3 SUNSET PLZ
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3660
Mailing Address - Country:US
Mailing Address - Phone:406-752-1166
Mailing Address - Fax:406-752-1171
Practice Address - Street 1:3 SUNSET PLZ
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3660
Practice Address - Country:US
Practice Address - Phone:406-752-1166
Practice Address - Fax:406-752-1171
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice