Provider Demographics
NPI:1700107661
Name:JOHNSON, AARON M (DMD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:M
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 1:2010 JUAN TABO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3306
Mailing Address - Country:US
Mailing Address - Phone:954-707-2241
Mailing Address - Fax:
Practice Address - Street 1:2010 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3306
Practice Address - Country:US
Practice Address - Phone:505-237-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46900802Medicaid