Provider Demographics
NPI:1356712731
Name:JOHANSEN, BRITTANY KRISTEN (DDS)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:KRISTEN
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:DUERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4057 W CIMARRON
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8518
Mailing Address - Country:US
Mailing Address - Phone:515-306-9012
Mailing Address - Fax:
Practice Address - Street 1:60 W MAIN STREET CT STE 100
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-4650
Practice Address - Country:US
Practice Address - Phone:801-899-9789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09324122300000X
UT12092409-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist