Organization
KEVIN B. JOHNSON, DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN BRADLEY JOHNSON DDS (DENTIST OWNER)
(208) 263-7641
Entity
Organization
Contact information
Practice address
1310 PONDEROSA DRIVE, SANDPOINT, ID 83864
(208) 263-7641
(208) 265-4333
Mailing address
1310 PONDEROSA DR STE A, SANDPOINT, ID 83864-5073
(208) 263-7641
(208) 265-4333
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3287
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804280700
—
ID
Enumeration date
01/23/2007
Last updated
06/25/2008
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