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NPI Code Detail

MEDICARE: JAMES B. JOHNSEN, D.M.D.

MEDICARE: JAMES B. JOHNSEN, D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry5676OR

General Provider Information

NPI Number : 1871760058
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAMES B. JOHNSEN, D.M.D.
Provider Business Mailing Address
First Line : 14125 SW FARMINGTON RD
Second Line :
City : BEAVERTON
State : OR
Zip : 97005-2567
Country : US
Telephone Number : 503-646-4432
Fax Number : 503-531-3757
Provider Business Practice Location Address
First Line : 14125 SW FARMINGTON RD
Second Line :
City : BEAVERTON
State : OR
Zip : 97005-2567
Country : US
Telephone Number : 503-646-4432
Fax Number : 503-531-3757
Authorized Official
Title or Position : OWNER
Name : DR. JAMES B JOHNSEN
Credential : DMD
Telephone Number : 503-646-4432
Provider Enumeration Date : 05/15/2008
Last Update Date : 05/15/2008

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