Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 5151071-9923 | UT |
N | 213EG0000X | General Practice | 5151071-9923 | UT |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DA031698 | PA |
NPI | 1013139567 |
---|---|
Provider Name | Kirk H. Johnson |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-3312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 17/08/2020 |