Provider Demographics
NPI:1790736825
Name:JOHNSON, KRISTOPHER ALLAN (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:ALLAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 106TH ST SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-4750
Mailing Address - Country:US
Mailing Address - Phone:425-348-8484
Mailing Address - Fax:425-348-6419
Practice Address - Street 1:4407 106TH ST SW
Practice Address - Street 2:SUITE A
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-4750
Practice Address - Country:US
Practice Address - Phone:425-348-8484
Practice Address - Fax:425-348-6419
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000062861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice