# KEVIN B. JOHNSON, DDS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568516714
- **Authorized official:** DR. KEVIN BRADLEY JOHNSON DDS (DENTIST OWNER)
- **Authorized official phone:** (208) 263-7641

## Contact information

- **Practice address:** 1310 PONDEROSA DRIVE, SANDPOINT, ID 83864
- **Practice address phone:** (208) 263-7641
- **Practice address fax:** (208) 265-4333
- **Mailing address:** 1310 PONDEROSA DR STE A, SANDPOINT, ID 83864-5073
- **Mailing address phone:** (208) 263-7641
- **Mailing address fax:** (208) 265-4333

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D3287 | ID | Yes |

## Other

- **Enumeration date:** 01/23/2007
- **Last updated:** 06/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 804280700 | — | ID |