Individual
KENNETH O JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
438 E 162ND ST, SOUTH HOLLAND, IL 60473-2258
(708) 333-0699
(708) 333-8252
Mailing address
438 E 162ND ST, SOUTH HOLLAND, IL 60473-2258
(708) 333-0699
(708) 333-8252
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
01/15/2007
Last updated
07/08/2007
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