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Organization
JORDAN LANDING PEDIATRICS
Active
Organization
JORDAN LANDING PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. R RYAN JOHANSEN D.D.S. (DOCTOR)
(801) 280-9595
Entity
Organization
Contact information
Practice address
7613 JORDAN LANDING BLVD, STE 210, WEST JORDAN, UT 84084-1972
(801) 280-9595
(801) 280-1169
Mailing address
7613 JORDAN LANDING BLVD, STE 210, WEST JORDAN, UT 84084-1972
(801) 280-9595
(801) 280-1169
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002204002
—
NV
05
—
528451522009
—
UT
Enumeration date
08/31/2010
Last updated
08/31/2010
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