Individual
DR. KENNETH JOHANNESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
79 MIDDLEVILLE RD, DVAMC NORTHPORT (160), NORTHPORT, NY 11768-2200
(631) 266-6057
(631) 266-6020
Mailing address
79 MIDDLEVILLE RD, NORTHPORT, NY 11768-2200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
044235
NY
Other
Enumeration date
05/20/2006
Last updated
07/12/2007
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