| Bryan D. Johnson, Dds, Pa | |
|
516 Main Street Madison Lake MN 56063 | |
| (507) 243-3747 | |
| (507) 243-3866 |
| Full Name | Bryan D. Johnson, Dds, Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 516 Main Street, Madison Lake, Minnesota |
| Authorized Official Name and Position | Bryan D. Johnson (DENTIST) |
| Authorized Official Contact | 5072433747 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bryan D. Johnson, Dds, Pa Po Box 458 Madison Lake MN 56063-0458 Ph: (507) 243-3747 | Bryan D. Johnson, Dds, Pa 516 Main Street Madison Lake MN 56063 Ph: (507) 243-3747 |
| NPI Number | 1043208267 |
|---|---|
| Provider Enumeration Date | 10/11/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043208267 | NPI | - | NPPES |
| 41321JO | Other | MN | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D9815 (Minnesota) | Primary |
Madison Lake Family Dental Care Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 516 Main St, Madison Lake, MN 56063 Phone: 507-243-3747 |