Individual
RONALD JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LD
Contact information
Practice address
4804 NE THURSTON WAY STE C, VANCOUVER, WA 98662-6478
(360) 892-7060
Mailing address
3101 SE BLAIRMONT DR, VANCOUVER, WA 98683-7653
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DN00000290
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659484244
—
WA
Enumeration date
06/25/2014
Last updated
06/25/2014
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