Individual
DR. KEVIN BRADLEY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1310 PONDEROSA DR, SANDPOINT, ID 83864-5073
(208) 263-7641
(208) 265-4333
Mailing address
1310 PONDEROSA DR, SANDPOINT, ID 83864-5073
(208) 263-7641
(208) 265-4333
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3287
ID
Other
Enumeration date
09/03/2013
Last updated
09/11/2013
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