Provider Demographics
NPI:1588662738
Name:JOHNSEN, JAMES B (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:JOHNSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14125 SW FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2567
Mailing Address - Country:US
Mailing Address - Phone:503-646-4432
Mailing Address - Fax:
Practice Address - Street 1:14125 SW FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2567
Practice Address - Country:US
Practice Address - Phone:503-646-4432
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5676208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice