Provider Demographics
NPI:1700693256
Name:MARK J JOHNSON DDS PA
Entity type:Organization
Organization Name:MARK J JOHNSON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-941-1911
Mailing Address - Street 1:6600 FRANCE AVE S STE 310
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1803
Mailing Address - Country:US
Mailing Address - Phone:952-941-1911
Mailing Address - Fax:
Practice Address - Street 1:6600 FRANCE AVE S STE 310
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1803
Practice Address - Country:US
Practice Address - Phone:952-941-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental