Provider Demographics
NPI:1740503564
Name:JOHNSON, BRANDON (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
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 1:1409 W 44TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1416
Mailing Address - Country:US
Mailing Address - Phone:913-620-6402
Mailing Address - Fax:
Practice Address - Street 1:2707 VINE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1949
Practice Address - Country:US
Practice Address - Phone:785-621-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS606161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics