Provider Demographics
NPI:1558751446
Name:JOHNSON, KRISTI (RDH)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5813 COUNTY ROAD 322
Mailing Address - Street 2:
Mailing Address - City:SILT
Mailing Address - State:CO
Mailing Address - Zip Code:81652-9828
Mailing Address - Country:US
Mailing Address - Phone:970-629-8176
Mailing Address - Fax:
Practice Address - Street 1:25 LOWER WOODBRIDGE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:SNOWMASS VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:81615
Practice Address - Country:US
Practice Address - Phone:970-923-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905864124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist