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General NPI Number Information
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NPI Number | 1447390240
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Entity Type | Organization
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Legal Business Name | KERRY K JOHNSON DDS PA
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 12/24/2007
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Provider Practice Location Address
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Address Line | 18046 FM 529
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City | CYPRESS
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State | TX
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Zip | 77433-1168
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Country | US
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Telephone | 832-593-0700
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Fax | 832-593-0600
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Provider Business Mailing Address
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Address Line | 18046 FM 529
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City | CYPRESS
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State | TX
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Zip | 77433-1168
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Country | US
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Telephone | 832-593-0700
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Fax | 832-593-0600
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | KERRY K JOHNSON
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Credential | DDS
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Telephone | 832-593-0700
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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 | 18293
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License Number State | TX
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