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Individual

DR. BAXTER E JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
501 S PRESTON ST, LOUISVILLE, KY 40292-0001
(502) 852-5128
(502) 852-7163
Mailing address
501 S PRESTON ST, LOUISVILLE, KY 40292-0001
(502) 852-5128
(502) 852-7163

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6185
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0004490
DORAL DENTAL
05
60061850
KY
Enumeration date
01/23/2007
Last updated
07/09/2007
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