Provider Demographics
NPI:1649539511
Name:JOHNSON, BRAD MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:MICHAEL
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 1:726 N GREENFIELD RD STE 126
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5063
Mailing Address - Country:US
Mailing Address - Phone:480-599-0074
Mailing Address - Fax:
Practice Address - Street 1:726 N GREENFIELD RD STE 126
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5063
Practice Address - Country:US
Practice Address - Phone:480-813-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0085101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice