Provider Demographics
NPI:1104989771
Name:JOHNSON, AARON DAVID (DMD)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:DAVID
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 MONTEGO DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0856
Mailing Address - Country:US
Mailing Address - Phone:701-426-3376
Mailing Address - Fax:
Practice Address - Street 1:726 S 2ND ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5718
Practice Address - Country:US
Practice Address - Phone:701-258-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1989122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist