Provider Demographics
NPI:1447390240
Name:KERRY K JOHNSON DDS PA
Entity Type:Organization
Organization Name:KERRY K JOHNSON DDS PA
Other - Org Name:JOHNSON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-593-0700
Mailing Address - Street 1:18046 FM 529
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1168
Mailing Address - Country:US
Mailing Address - Phone:832-593-0700
Mailing Address - Fax:832-593-0600
Practice Address - Street 1:18046 FM 529
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1168
Practice Address - Country:US
Practice Address - Phone:832-593-0700
Practice Address - Fax:832-593-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty