Provider Demographics
NPI:1770603276
Name:JOHNSON, DANIEL R (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
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:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-0031
Mailing Address - Country:US
Mailing Address - Phone:308-432-5623
Mailing Address - Fax:308-432-3333
Practice Address - Street 1:259 KING ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2351
Practice Address - Country:US
Practice Address - Phone:308-432-5623
Practice Address - Fax:308-432-3333
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE43211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice