Individual
DR. KEITH A. JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
206 E MAIN ST, LAKE MILLS, IA 50450-1410
(641) 592-2200
(641) 592-2202
Mailing address
206 E MAIN ST, LAKE MILLS, IA 50450-1410
(641) 592-2200
(641) 592-2202
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6195
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0135715
—
IA
Enumeration date
10/11/2006
Last updated
07/08/2007
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