Provider Demographics
NPI:1649022880
Name:JOHNSON, BRIAN MICHAEL (DMD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MICHAEL
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:RYERSON AND ASSOCIATES
Mailing Address - Street 2:1013 E. AVALON AVE.
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661
Mailing Address - Country:US
Mailing Address - Phone:256-383-2100
Mailing Address - Fax:256-381-4844
Practice Address - Street 1:PROMEDICA TOLEDO HOSPITAL
Practice Address - Street 2:2109 HUGHES DR. JOBST TOWER 6TH FLOOR
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-291-7222
Practice Address - Fax:419-291-8095
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007395-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty