Provider Demographics
NPI:1205132693
Name:JOHNSON, JAMES KEITH (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KEITH
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 W HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-1367
Mailing Address - Country:US
Mailing Address - Phone:541-944-1427
Mailing Address - Fax:541-732-3083
Practice Address - Street 1:2936 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8309
Practice Address - Country:US
Practice Address - Phone:541-779-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD4738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist