Provider Demographics
NPI:1467466532
Name:JOHNSON, KENT N (DMD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:N
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 1:7138 HIGHLAND DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3757
Mailing Address - Country:US
Mailing Address - Phone:801-943-7607
Mailing Address - Fax:801-943-9193
Practice Address - Street 1:7138 HIGHLAND DR
Practice Address - Street 2:SUITE 220
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3757
Practice Address - Country:US
Practice Address - Phone:801-943-7607
Practice Address - Fax:801-943-9193
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT132822-8903122300000X
UT132822-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice