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Individual
DR. TYLER RUSSELL JOHANSEN
Active
Individual
DR. TYLER RUSSELL JOHANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS039183
PA
1223P0300X
Periodontics
Primary
DS039183
PA
Other
Enumeration date
08/01/2012
Last updated
05/21/2025
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