| Jordan Landing Pediatrics | |
|
7613 Jordan Landing Blvd Ste 210 West Jordan UT 84084-1972 | |
| (801) 280-9595 | |
| (801) 280-1169 |
| Full Name | Jordan Landing Pediatrics |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 7613 Jordan Landing Blvd, West Jordan, Utah |
| Authorized Official Name and Position | R Ryan Johansen (DOCTOR) |
| Authorized Official Contact | 8012809595 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jordan Landing Pediatrics 7613 Jordan Landing Blvd Ste 210 West Jordan UT 84084-1972 Ph: (801) 280-9595 | Jordan Landing Pediatrics 7613 Jordan Landing Blvd Ste 210 West Jordan UT 84084-1972 Ph: (801) 280-9595 |
| NPI Number | 1528374337 |
|---|---|
| Provider Enumeration Date | 08/31/2010 |
| Last Update Date | 08/31/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528374337 | NPI | - | NPPES |
| 002204002 | Medicaid | NV | |
| 528451522009 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
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