# JORDAN LANDING PEDIATRIC DENTISTRY DDS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jordan Landing Pediatric Dentistry DDS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265215347
- **Authorized official:** RYAN RICHARD JOHANSEN DDS (DENTIST)
- **Authorized official phone:** (801) 280-9595

## Contact information

- **Practice address:** 7613 S JORDAN LANDING BLVD STE 210, WEST JORDAN, UT 84084-1973
- **Practice address phone:** (801) 280-9595
- **Mailing address:** 7613 S JORDAN LANDING BLVD STE 210, WEST JORDAN, UT 84084-1973
- **Mailing address phone:** (385) 209-5038
- **Mailing address fax:** (801) 280-1169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/14/2023
- **Last updated:** 08/14/2023