Provider Demographics
NPI:1154529121
Name:JOHNSON, ELI K (DDS)
Entity type:Individual
Prefix:DR
First Name:ELI
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N 10TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2389
Mailing Address - Country:US
Mailing Address - Phone:406-363-2421
Mailing Address - Fax:406-363-4541
Practice Address - Street 1:215 N 10TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2389
Practice Address - Country:US
Practice Address - Phone:406-363-2421
Practice Address - Fax:406-363-4541
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2242122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist