Provider Demographics
NPI:1699766774
Name:JOHNS, KEITH DENNIS (DMD, MBA)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:DENNIS
Last Name:JOHNS
Suffix:
Gender:M
Credentials:DMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 W WOODS RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1916
Mailing Address - Country:US
Mailing Address - Phone:203-248-7357
Mailing Address - Fax:
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-867-5415
Practice Address - Fax:203-789-5912
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT71051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice