Provider Demographics
NPI:1427211408
Name:JOHNSON, KATHERINE TAITE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:TAITE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8490 E. CRESCENT PKWY
Mailing Address - Street 2:SUITE 370
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111
Mailing Address - Country:US
Mailing Address - Phone:303-740-9353
Mailing Address - Fax:303-740-6915
Practice Address - Street 1:8490 E. CRESCENT PKWY
Practice Address - Street 2:SUITE 370
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-740-9353
Practice Address - Fax:303-740-6915
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice