MEDICARE: DR. KEVIN MCBETH JOHNSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	10972	SC

General Provider Information

NPI Number	:	1194954255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN MCBETH JOHNSON DDS

Provider Business Mailing Address
First Line	:	PO BOX 357
Second Line	:
City	:	RIDGELAND
State	:	SC
Zip	:	29936-2605
Country	:	US
Telephone Number	:	843-987-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	6315 JONATHAN FRANCIS SR RD
Second Line	:
City	:	SAINT HELENA ISLAND
State	:	SC
Zip	:	29920-5310
Country	:	US
Telephone Number	:	843-987-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2009
Last Update Date	:	12/17/2024

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