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General NPI Number Information
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NPI Number | 1649493784
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Entity Type | Individual
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Provider Name | KURT A JOHNSON DMD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3822 WAYNE ST
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City | ERIE
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State | PA
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Zip | 16504-2275
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Country | US
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Telephone | 814-825-8021
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Fax |
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Provider Business Mailing Address
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Address Line | 229 EDGEWATER CIR
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City | ERIE
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State | PA
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Zip | 16509-3785
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Country | US
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Telephone | 814-825-1789
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS028655L
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License Number State | PA
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