Individual
WILLIAM LEE JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1160 LIBERTY ST SE, SALEM, OR 97302-4143
(503) 363-3311
Mailing address
1160 LIBERTY STREET SE, SALEM, OR 97302
(503) 363-3311
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7254
OR
Other
Enumeration date
11/27/2006
Last updated
07/08/2007
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