Provider Demographics
NPI:1013079060
Name:JOHNSON, KERRY ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:ALAN
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 1:3244 HARRISBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:LANDISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17538-1316
Mailing Address - Country:US
Mailing Address - Phone:717-898-7733
Mailing Address - Fax:717-898-9802
Practice Address - Street 1:3244 HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:LANDISVILLE
Practice Address - State:PA
Practice Address - Zip Code:17538-1316
Practice Address - Country:US
Practice Address - Phone:717-898-7733
Practice Address - Fax:717-898-9802
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
PADS-29400-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment