Doctor Name: | DR. MARY BETH JOHNSON |
NPI Number: | 1437292570 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DDS |
License Number: | 30-020478 |
Business Practice Address: | Hwy 264, Mp 388 Polacca, AZ - 86042 |
Business Phone Number: | 9287376162 |
Business Fax Number: | |
Mailing Address: | Hopi Health Care Center Keams Canyon S.u., Po Box 4000 POLACCA |
State: | AZ |
Postal Code: | 86042 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/15/2007 |
NPI Last Update Date: | 06/26/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 30-020478 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |