Organization
WENATCHEE VALLEY ORAL AND FACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMIAH JOHNSON DDS, MD (DOCTOR)
(509) 663-0060
Entity
Organization
Contact information
Practice address
620 N EMERSON AVE, SUITE 101, WENATCHEE, WA 98801-6619
(509) 663-0068
(509) 663-0060
Mailing address
620 N EMERSON AVE, SUITE 101, WENATCHEE, WA 98801-6619
(509) 663-0068
(509) 663-0060
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
D9077
OR
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
DE60337452
WA
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
MD60336798
WA
Other
Enumeration date
03/07/2014
Last updated
03/07/2014
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