Provider Demographics
NPI:1033263355
Name:JOHNSON, CHRISTIAN E (DDS)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:CHRIS
Other - Middle Name:E
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7405 W GRANDRIDGE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-735-6341
Mailing Address - Fax:509-735-1877
Practice Address - Street 1:7405 W GRANDRIDGE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6708
Practice Address - Country:US
Practice Address - Phone:509-735-6341
Practice Address - Fax:509-735-1877
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5008602Medicaid