1093704124 NPI number — CHRISTOPHER M JOHNSON DDS

Table of content: CHRISTOPHER M JOHNSON DDS (NPI 1093704124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093704124 NPI number — CHRISTOPHER M JOHNSON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
CHRISTOPHER
Provider Middle Name:
M
Provider Name Prefix Text:
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:
1093704124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10511 E RIVERVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55347-4918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-941-9007
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EXCELSIOR
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55331-2038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-474-6133
Provider Business Practice Location Address Fax Number:
952-474-7361
Provider Enumeration Date:
10/20/2005

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:  D11061 , 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)

  • Identifier: 020998800 . This is a "MN CARE ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com