# J. GRANT JOHANSEN DMD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316416621
- **Authorized official:** DR. JUSTIN GRANT JOHANSEN DMD, MPH (DENTIST, OWNER)
- **Authorized official phone:** (480) 254-6712

## Contact information

- **Practice address:** 3800 W RAY RD STE 11, CHANDLER, AZ 85226-5940
- **Practice address phone:** (480) 345-0530
- **Practice address fax:** (480) 345-0048
- **Mailing address:** 3800 W RAY RD STE 11, CHANDLER, AZ 85226-5940
- **Mailing address phone:** (480) 345-0530
- **Mailing address fax:** (480) 345-0048

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/15/2018
- **Last updated:** 11/15/2018