| Kevin B. Johnson, Dds | |
|
1310 Ponderosa Drive Sandpoint ID 83864 | |
| (208) 263-7641 | |
| (208) 265-4333 |
| Full Name | Kevin B. Johnson, Dds |
|---|---|
| Speciality | Dentist |
| Location | 1310 Ponderosa Drive, Sandpoint, Idaho |
| Authorized Official Name and Position | Kevin Bradley Johnson (DENTIST OWNER) |
| Authorized Official Contact | 2082637641 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kevin B. Johnson, Dds 1310 Ponderosa Dr Ste A Sandpoint ID 83864-5073 Ph: (208) 263-7641 | Kevin B. Johnson, Dds 1310 Ponderosa Drive Sandpoint ID 83864 Ph: (208) 263-7641 |
| NPI Number | 1568516714 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 06/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568516714 | NPI | - | NPPES |
| 804280700 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D3287 (Idaho) | Primary |
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