Individual
KEVIN J JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
603 BEMIDJI AVE N, BEMIDJI, MN 56601-3015
(218) 751-4523
(218) 751-0285
Mailing address
PO BOX 338, BEMIDJI, MN 56619-0338
(218) 751-4523
(218) 751-0285
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10118
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
628820100
—
MN
Enumeration date
11/16/2006
Last updated
12/21/2009
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