Individual
DR. ROBERT W. JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5000 MENAUL BLVD NE STE B, ALBUQUERQUE, NM 87110-3046
(614) 425-1381
Mailing address
4777 TRAMWAY BLVD NE, APT 607, ALBUQUERQUE, NM 87111-2974
(614) 425-1381
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
30.022825
OH
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
50 054893
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DEN.00202093
CO
Other
Enumeration date
06/08/2007
Last updated
09/29/2014
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