Organization
PACIFIC NORTHWEST ORAL AND MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL KENNETH JOHNSON DDS (OWNER)
(425) 277-1844
Entity
Organization
Contact information
Practice address
2345 SW 320TH ST, FEDERAL WAY, WA 98023-2568
(253) 838-2123
(253) 874-3624
Mailing address
2345 SW 320TH ST, FEDERAL WAY, WA 98023-2568
(253) 838-2123
(253) 874-3624
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
DE00006475
WA
Other
Enumeration date
07/01/2014
Last updated
07/01/2014
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