Individual
KEN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
918 E PARK AVENUE PLZ, BELOIT, WI 53511-1753
(608) 365-9456
Mailing address
918 E PARK AVENUE PLZ, BELOIT, WI 53511-1753
(608) 365-9456
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4352
WI
Other
Enumeration date
11/09/2006
Last updated
03/16/2012
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