Provider Demographics
NPI:1649022880
Name:JOHNSON, BRIAN MICHAEL (DMD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PROMEDICA TOLEDO HOSPITAL
Mailing Address - Street 2:2109 HUGHES DR. JOBST TOWER 6TH FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606
Mailing Address - Country:US
Mailing Address - Phone:419-291-7222
Mailing Address - Fax:419-291-8095
Practice Address - Street 1:PROMEDICA TOLEDO HOSPITAL
Practice Address - Street 2:2109 HUGHES DR. JOBST TOWER 6TH FLOOR
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-291-7222
Practice Address - Fax:419-291-8095
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program