Individual
DR. ROGER EDMUND JOHANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
110 BERGEN ST, NJDS ROOM D 837, NEWARK, NJ 07103-2495
(973) 972-4526
Mailing address
518 GREGORY AVE, A-105, WEEHAWKEN, NJ 07086-5706
(201) 920-9026
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
14977
NJ
Other
Enumeration date
03/13/2007
Last updated
07/08/2007
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