Organization
MACK S JOHNSEN DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MACK S JOHNSEN (DENTIST)
(503) 682-2110
Entity
Organization
Contact information
Practice address
29990 SW TOWN CENTER LP, SUITE A, WILSONVILLE, OR 97070
(503) 682-2110
Mailing address
29990 SW TOWN CENTER LP W, SUITE A, WILSONVILLE, OR 97070
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4949
OR
Other
Enumeration date
05/14/2008
Last updated
05/14/2008
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