Organization
ROSE PARK PEDIATRIC DENTISTRY, PC
Active
Parent organization
49534949923
Organization subpart
Yes
Provider details
NPI number
Legal business name
49534949923
Authorized official
DR. RICHARD RYAN JOHANSEN DDS (OWNER)
(801) 519-2222
Entity
Organization
Contact information
Practice address
55 N REDWOOD RD STE B, SALT LAKE CITY, UT 84116-3174
(801) 519-2222
Mailing address
55 N REDWOOD RD STE B, SALT LAKE CITY, UT 84116-3174
(801) 519-2222
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
49534949923
UT
Other
Enumeration date
02/18/2009
Last updated
02/18/2009
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