Dr. Kirby Charles Johnson, DDS
Dentist, Oral and Maxillofacial Surgery in St Anthony, MN. Individual provider (NPI-1).
NPI number1023045341
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1023045341
- Entity type
- Individual (NPI-1)
- Name
- Dr. Kirby Charles Johnson
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 26, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 10472DDS | MN | Yes |
Practice location
3905 Silver Lake RdSt Anthony, MN 55421
Phone 612-788-9246 · Fax 612-788-5511
Mailing address
320 Calamus CircleMedina, MN 55340
Phone 612-788-9246 · Fax 612-788-5511
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