| Collis Johnson Jr Dds | |
|
1756 Vine Street Denver CO 80206 | |
| (303) 322-1177 | |
| (303) 322-1199 |
| Full Name | Collis Johnson Jr Dds |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1756 Vine Street, Denver, Colorado |
| Authorized Official Name and Position | Collis Johnson (DENTIST/OWNER) |
| Authorized Official Contact | 3033221177 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Collis Johnson Jr Dds 1756 Vine Street Denver CO 80206 Ph: (303) 322-1177 | Collis Johnson Jr Dds 1756 Vine Street Denver CO 80206 Ph: (303) 322-1177 |
| NPI Number | 1558607242 |
|---|---|
| Provider Enumeration Date | 12/27/2012 |
| Last Update Date | 12/27/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558607242 | NPI | - | NPPES |
| 02014769 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 104176 (Colorado) | Primary |
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