Provider Demographics
NPI:1811149297
Name:DENNIS D. JOHNSON DMD PC
Entity type:Organization
Organization Name:DENNIS D. JOHNSON DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-581-9419
Mailing Address - Street 1:410 LANCASTER DR NE STE A
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4794
Mailing Address - Country:US
Mailing Address - Phone:503-581-9419
Mailing Address - Fax:503-581-0438
Practice Address - Street 1:410 LANCASTER DR NE STE A
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4794
Practice Address - Country:US
Practice Address - Phone:503-581-9419
Practice Address - Fax:503-581-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD4839261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery