1891785549 NPI number — DR. RICHARD EDWIN JOHNSON DDS

Table of content: DR. RICHARD EDWIN JOHNSON DDS (NPI 1891785549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891785549 NPI number — DR. RICHARD EDWIN JOHNSON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
RICHARD
Provider Middle Name:
EDWIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891785549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18057 BARIUM ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAMSEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55303-3391
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-753-6371
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
229 JACKSON ST
Provider Second Line Business Practice Location Address:
117
Provider Business Practice Location Address City Name:
ANOKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55303-2287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-421-3330
Provider Business Practice Location Address Fax Number:
763-421-3331
Provider Enumeration Date:
10/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  9277 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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