| NPI | 1922212901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL M JOHNSON Medical Director Health Officer 906-315-2607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2020-08-22 |