JOSEPH G JOHANSEN DDS PC
Ambulatory Health in Mesa, AZ

License number
Arizona AZ3185
Category
Ambulatory Health
Type
Oral and Maxillofacial Surgery
Owner
Name: JOSEPH GRANT JOHANSEN DDS
Title: ORAL MAXILLOFACIAL SURGEON
Phone: (480) 632-1508
Address
Address
3048 E Baseline Rd Suite #105, Mesa, AZ 85204
National Provider ID: 1649459926
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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JOSEPH G. JOHANSEN, D.D.S., PC

Mesa, AZ

Status:
Inactive
Industry:
Dental Office
Doing business as:
Joseph G Johansen DDS PC
Inactive reason:
Ad-dissolved-file annual report
Registration:
Dec 30, 1986
Inactive since:
Jun 13, 2011
Phone:
(480) 833-5230 (Phone)
Addresses:
855 E Brown Rd #10, Mesa, AZ 85203 (Physical)
3048 E Baseline Rd, Mesa, AZ 85204
State ID:
-0192042-3
Expiration:
PERPETUAL
Director, Presidents:
Joseph G Johansen Dds (President/ceo), 855 E Brown Rd #10, Mesa, AZ 85203 (Physical),Joseph G Johansen (Director, President), Director 2119 East Nantuckett, Gilbert, AZ 85234 (Physical)
Agent:
Joseph G Johnsen,3048 E Baseline Rd #105 MESA AZ, Mesa, AZ 85204 (Physical)
2119 E Nantuckett, Gilbert, AZ 85234 (Physical)

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