Healthcare Provider Details

I. General information

NPI: 1811149297
Provider Name (Legal Business Name): DENNIS D. JOHNSON DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LANCASTER DR NE STE A
SALEM OR
97301-4794
US

IV. Provider business mailing address

410 LANCASTER DR NE STE A
SALEM OR
97301-4794
US

V. Phone/Fax

Practice location:
  • Phone: 503-581-9419
  • Fax: 503-581-0438
Mailing address:
  • Phone: 503-581-9419
  • Fax: 503-581-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberD4839
License Number StateOR

VIII. Authorized Official

Name: DR. DENNIS D JOHNSON
Title or Position: PRESIDENT
Credential: DMD
Phone: 503-581-9419