Individual
KIMBERLY ANN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1314 NE GRAND AVE, PORTLAND, OR 97232-1127
(503) 280-2877
Mailing address
15048 NE ROSE PKWY, PORTLAND, OR 97230-4523
(503) 577-3995
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H3114
OR
124Q00000X
Dental Hygienist
HL00007793
WA
Other
Enumeration date
05/21/2007
Last updated
07/08/2007
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