Johnson, Kelly Wade

Johnson, Kelly Wade is an individual health care provider with primary practice located at 2815 S Pennsylvania Ave #203, Lansing MI 48910-3495. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Johnson, Kelly Wade can be contacted via phone (517) 272-4150.

Contact Information

Primary practice address
2815 S Pennsylvania Ave #203 Lansing MI 48910-3495
Phone: (517) 272-4150
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 2901018145 Michigan

Profile Details

NPI number 1467431932
LBN Legal business name Johnson, Kelly Wade
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 12th, 2006
Last updated Sep 10th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467431932 NPPES
Michigan Other 1385419 UNITED CONCORDIA
Michigan Other 161661900 UNITED CONCORDIA
Michigan Other 161661900 UNITED CONCORDIA
Michigan MEDICAID 4530810 UNITED CONCORDIA

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