Individual
DR. KIRBY CHARLES JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3905 SILVER LAKE RD, ST ANTHONY, MN 55421
(612) 788-9246
(612) 788-5511
Mailing address
320 CALAMUS CIRCLE, MEDINA, MN 55340
(612) 788-9246
(612) 788-5511
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10472DDS
MN
Other
Enumeration date
06/26/2006
Last updated
07/08/2007
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