Individual
RYAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
97829 SHOPPING CENTER AVE, BROOKINGS, OR 97415-9135
(541) 813-7000
Mailing address
442 SW UMATILLA AVE STE 200, REDMOND, OR 97756-7039
(888) 468-0022
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D11467
OR
1223G0001X
General Practice Dentistry
Primary
D11467
OR
Other
Enumeration date
07/08/2021
Last updated
07/08/2021
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