Individual
DR. KELLY J JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
7420 SW BRIDGEPORT RD, SUITE 104, TIGARD, OR 97224-7790
(503) 430-7909
(503) 268-1501
Mailing address
7420 SW BRIDGEPORT RD, SUITE 104, TIGARD, OR 97224-7790
(503) 430-7909
(503) 268-1501
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7482
OR
Other
Enumeration date
11/05/2009
Last updated
03/20/2012
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