Individual
DR. KENNETH WAYNE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
704 HILLCREST, TUPELO, MS 38804
(662) 840-8540
(662) 840-0629
Mailing address
1407 MITTS DR, TUPELO, MS 38801-2215
(662) 840-8540
(662) 840-0629
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
PEDO29796
MS
Other
Enumeration date
10/17/2006
Last updated
07/08/2007
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