Provider Demographics
NPI:1992848956
Name:JOHANSEN, R RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:R RYAN
Middle Name:
Last Name:JOHANSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7613 JORDAN LANDING BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1972
Mailing Address - Country:US
Mailing Address - Phone:801-280-9595
Mailing Address - Fax:801-280-1169
Practice Address - Street 1:7613 JORDAN LANDING BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1972
Practice Address - Country:US
Practice Address - Phone:801-280-9595
Practice Address - Fax:801-280-1169
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT495349499221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry