Mary Johnson

NPI 1467868414 · on the registry since 2014

Practice

Address: 855 S Randall Rd
St Charles, IL 60174
Phone: (616) 430-9555
Organisation at this address: St..Charles Modern Dental Llc
St. Charles Modern Dental, Llc
Meijer Great Lakes Limited Partnership
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 3

Registry record

Primary taxonomy: 1835P1200X
1835P1200X
Licence states on file: IL
From the registry's licence fields, which are often incomplete.
Sex: Female
Record last updated: 2014-07-09

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois