DR. Kenneth Johannesen, DDS

NPI #1477507754 in Northport, New York

Provider Information

NPI Number: 1477507754
Entity Type: Individual
Name: DR. Kenneth Johannesen, DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: May 20, 2006
Last Updated: Jul 12, 2007

Practice Location

Address: 79 MIDDLEVILLE RD
Address 2: DVAMC NORTHPORT (160)
City: Northport
State: New York
ZIP Code: 11768-2200
Phone: (631) 266-6057

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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