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Individual

DR. JUSTIN GRANT JOHANSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.M.D

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D009269
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
D009269
ARIZONA STATE LICENSE
AZ
Enumeration date
06/17/2015
Last updated
06/17/2015
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