Individual
DR. KELLEY PURVIS JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
1454 MADISON AVE W, IMMOKALEE, FL 34142-2200
(239) 658-3000
Mailing address
18121 LAGOS WAY, NAPLES, FL 34110-2764
(239) 597-2437
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN15182
FL
Other
Enumeration date
11/02/2006
Last updated
07/08/2007
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