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General NPI Number Information
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NPI Number | 1962763193
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Entity Type | Individual
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Provider Name | KELLY ANN JOHNSON D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 2020 N WEBB RD STE 301
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City | WICHITA
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State | KS
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Zip | 67206-3410
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Country | US
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Telephone | 316-687-2110
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Fax |
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Provider Business Mailing Address
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Address Line | 229 S BLECKLEY DR
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City | WICHITA
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State | KS
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Zip | 67218-1521
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Country | US
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Telephone | 316-250-6090
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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 | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | KS60821
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License Number State | KS
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