Johansen, Justin Grant
Johansen, Justin Grant is an individual health care provider with primary practice located at 3800 W Ray Rd Ste 11 , Chandler AZ 85226-5940. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Johansen, Justin Grant can be contacted via phone (480) 345-0530.Contact Information
Primary practice address
3800 W Ray Rd Ste 11
Chandler AZ 85226-5940
Phone: (480) 345-0530
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | D009269 | Arizona |
Profile Details
| NPI number | 1215318977 |
|---|---|
| LBN Legal business name | Johansen, Justin Grant |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 17th, 2015 |
| Last updated | Jun 17th, 2015 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215318977 | NPPES |
| Arizona | Other | D009269 | ARIZONA STATE LICENSE |
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