Provider Demographics
NPI:1477657161
Name:JOHNSON, WILLIAM THOMAS (DDS MS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:257 S DENTAL SCIENCE BLDG
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1001
Mailing Address - Country:US
Mailing Address - Phone:319-335-7431
Mailing Address - Fax:319-335-7155
Practice Address - Street 1:322 S DENTAL SCIENCE BLDG
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1001
Practice Address - Country:US
Practice Address - Phone:319-384-1139
Practice Address - Fax:319-384-1785
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA060631223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1077396Medicaid