Individual
RYAN DARREN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
6704 SUMAC RIDGE DR, CRESTWOOD, KY 40014-9324
(505) 925-4031
(505) 925-4030
Mailing address
6704 SUMAC RIDGE DR, CRESTWOOD, KY 40014-9324
(505) 925-4031
(505) 925-4030
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12103826-9923
UT
1223P0300X
Periodontics
Primary
10576
KY
390200000X
Student in an Organized Health Care Education/Training Program
TD-00-131
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
Other
Enumeration date
04/22/2020
Last updated
07/09/2021
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