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Organization
BRIDGEPORT FAMILY DENTAL, LLC
Active
Organization
BRIDGEPORT FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY JEAN JOHNSON D.D.S. (OWNER/DENTIST)
(503) 430-7909
Entity
Organization
Contact information
Practice address
7420 SW BRIDGEPORT RD STE 104, TIGARD, OR 97224-7790
(503) 430-7909
(503) 268-1501
Mailing address
7420 SW BRIDGEPORT RD STE 104, TIGARD, OR 97224-7790
(503) 430-7909
(503) 268-1501
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D7482
OR
Other
Enumeration date
02/15/2012
Last updated
02/15/2012
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