Provider Demographics
NPI:1962511626
Name:JOHNSON, KRISTI ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KRISTI
Other - Middle Name:ANNE
Other - Last Name:HUETTL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:505 WOODLEY ST W
Mailing Address - Street 2:PO BOX 308
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-1681
Mailing Address - Country:US
Mailing Address - Phone:507-645-9669
Mailing Address - Fax:507-645-8341
Practice Address - Street 1:505 WOODLEY ST W
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-1681
Practice Address - Country:US
Practice Address - Phone:507-645-9669
Practice Address - Fax:507-645-8341
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2009-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist