Provider Demographics
NPI:1750949012
Name:MASHAK JOHNSON, HILLARY NOELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:HILLARY
Middle Name:NOELLE
Last Name:MASHAK JOHNSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 PARK CENTER BLVD APT 715
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2565
Mailing Address - Country:US
Mailing Address - Phone:608-632-2566
Mailing Address - Fax:
Practice Address - Street 1:654 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-9632
Practice Address - Country:US
Practice Address - Phone:612-712-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND141491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice