Provider Demographics
NPI:1245839331
Name:ANDREW D JOHNSON DDS
Entity type:Organization
Organization Name:ANDREW D JOHNSON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-838-1300
Mailing Address - Street 1:2203 N SWEETBRIAR ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-5518
Mailing Address - Country:US
Mailing Address - Phone:316-838-1300
Mailing Address - Fax:
Practice Address - Street 1:2203 N SWEETBRIAR ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67204-5518
Practice Address - Country:US
Practice Address - Phone:316-838-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS61357OtherKANSAS DENTAL BOARD