Individual
DOUGLAS SCOTT JOHANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
57418 COUNTY ROAD 681, HARTFORD, MI 49057-9421
(269) 621-3143
Mailing address
2611 S CLEVELAND AVE, SAINT JOSEPH, MI 49085-3001
(269) 408-1225
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901018068
MI
Other
Enumeration date
03/05/2007
Last updated
07/08/2007
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