Individual
DR. DENNIS DOUGLAS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
410 LANCASTER DR NE, SUITE A, SALEM, OR 97301-4794
(503) 581-9419
(503) 581-0438
Mailing address
410 LANCASTER DR NE, SUITE A, SALEM, OR 97301-4794
(503) 581-9419
(503) 581-0438
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D4839
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14097-0
—
OR
Enumeration date
04/12/2007
Last updated
07/09/2007
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