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General NPI Number Information
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NPI Number | 1386197564
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Entity Type | Individual
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Provider Name | ERIN KATHLEEN JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 246 PUBLIC SQ
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City | GREENFIELD
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State | IA
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Zip | 50849-1258
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Country | US
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Telephone | 416-743-2314
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 JORDAN GRV
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City | WEST DES MOINES
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State | IA
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Zip | 50265-6467
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Country | US
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Telephone | 515-720-5129
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS-09491
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License Number State | IA
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