Provider Demographics
NPI:1073670394
Name:JOHNSON, RONALD TODD (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:TODD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:BUILDING E, SUITE 204
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-663-1080
Mailing Address - Fax:719-652-7179
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BUILDING E, SUITE 204
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-663-1080
Practice Address - Fax:719-652-7179
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6693122300000X
NC9025122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist