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Individual

CHARLES KEITH JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
1405 WESTOVER HILLS BLVD, #1, RICHMOND, VA 23225
(804) 232-1533
(804) 232-1560
Mailing address
1405 WESTOVER HILLS BLVD, #1, RICHMOND, VA 23225
(804) 232-1533
(804) 232-1560

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5082
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
103763
ANTHEM
VA
05
541035205
VA
01
805392
UNITED CONCORDIA
VA
Enumeration date
06/14/2006
Last updated
07/24/2012
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