| D. Todd Johnson Dds, Pc | |
|
4716 W Urbana St Broken Arrow OK 74012-5997 | |
| (918) 449-5800 | |
| (918) 455-8958 |
| Full Name | D. Todd Johnson Dds, Pc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 4716 W Urbana St, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Julia E Sams (CONTRACT COORDINATOR) |
| Authorized Official Contact | 9184495800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| D. Todd Johnson Dds, Pc 4716 W Urbana St Broken Arrow OK 74012-5997 Ph: (918) 449-5800 | D. Todd Johnson Dds, Pc 4716 W Urbana St Broken Arrow OK 74012-5997 Ph: (918) 449-5800 |
| NPI Number | 1912221052 |
|---|---|
| Provider Enumeration Date | 03/18/2010 |
| Last Update Date | 12/20/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912221052 | NPI | - | NPPES |
| 100091300A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 5019 (Oklahoma) | Primary |
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