Provider Demographics
NPI:1821134370
Name:JOHNSON, GREGORY HUNTER (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:HUNTER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS MS
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2350 SOUTH DIXON ROAD
Mailing Address - Street 2:SUITE 425
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-6422
Mailing Address - Country:US
Mailing Address - Phone:765-453-6000
Mailing Address - Fax:765-453-6562
Practice Address - Street 1:2350 SOUTH DIXON ROAD
Practice Address - Street 2:SUITE 425
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6422
Practice Address - Country:US
Practice Address - Phone:765-453-6000
Practice Address - Fax:765-453-6562
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN12007423A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry