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Organization

JORDAN LANDING PEDIATRICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. R RYAN JOHANSEN D.D.S. (DOCTOR)
(801) 280-9595
Entity
Organization

Contact information

Practice address
7613 JORDAN LANDING BLVD, STE 210, WEST JORDAN, UT 84084-1972
(801) 280-9595
(801) 280-1169
Mailing address
7613 JORDAN LANDING BLVD, STE 210, WEST JORDAN, UT 84084-1972
(801) 280-9595
(801) 280-1169

Taxonomy

Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
002204002
NV
05
528451522009
UT
Enumeration date
08/31/2010
Last updated
08/31/2010
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