Organization
JOSEPH G JOHANSEN DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH GRANT JOHANSEN DDS (ORAL MAXILLOFACIAL SURGEON)
(480) 632-1508
Entity
Organization
Contact information
Practice address
3048 E BASELINE RD, SUITE #105, MESA, AZ 85204-7286
(480) 632-8848
Mailing address
3048 E BASELINE RD, SUITE #105, MESA, AZ 85204-7286
(480) 632-8848
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
AZ3185
AZ
Other
Enumeration date
11/02/2007
Last updated
11/02/2007
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