Provider Demographics
NPI:1487784419
Name:RCJ DENTAL PC
Entity type:Organization
Organization Name:RCJ DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-968-6101
Mailing Address - Street 1:11815 SW KING JAMES PL STE 10
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-2479
Mailing Address - Country:US
Mailing Address - Phone:503-968-6101
Mailing Address - Fax:503-968-6717
Practice Address - Street 1:11815 SW KING JAMES PL STE 10
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-2479
Practice Address - Country:US
Practice Address - Phone:503-968-6101
Practice Address - Fax:503-968-6717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD70751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty