Provider Demographics
NPI:1679909212
Name:JOHNSON, KRISTY LYNN (DDS)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 SUPERIOR DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8525
Mailing Address - Country:US
Mailing Address - Phone:304-841-3063
Mailing Address - Fax:
Practice Address - Street 1:2647 SUPERIOR DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8525
Practice Address - Country:US
Practice Address - Phone:304-841-3063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-14
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNS1101223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics