Provider Demographics
NPI:1922213636
Name:JOHNSON-KOOS, DENISE RENEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:RENEE
Last Name:JOHNSON-KOOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 29TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3416
Mailing Address - Country:US
Mailing Address - Phone:541-967-8566
Mailing Address - Fax:
Practice Address - Street 1:1020 29TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3416
Practice Address - Country:US
Practice Address - Phone:541-967-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice