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General NPI Number Information
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NPI Number | 1366756389
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW ORAL SURGERY AND DENTAL IMPLANTS
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 1046 NE 3RD ST
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City | MCMINNVILLE
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State | OR
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Zip | 97128-4418
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Country | US
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Telephone | 503-472-1468
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Fax | 503-434-9214
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Provider Business Mailing Address
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Address Line | 1046 NE 3RD ST
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City | MCMINNVILLE
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State | OR
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Zip | 97128-4418
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Country | US
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Telephone | 503-472-1468
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Fax | 503-434-9214
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Authorized Official
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Title or Position | ORAL SURGEON / OWNER
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Name | DR. MARVIN J JOHNSON
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Credential | DMD
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Telephone | 503-472-1468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D9272
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D5964
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License Number State | OR
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