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Deactivated NPI 1205008034 Deactivated / Inactive NPI Male Practitioner

Dr. Mack S Johnsen , DMD, PC

Dentist - General Practice • Wilsonville, OR

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Mack Johnsen has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date April 01, 2008
NPI Deactivation Date September 27, 2023
Total Practice Duration ~15 Years of Practice (2008 – 2023)

Professional Overview & Biography Verified Profile Summary

Dr. Mack Johnsen, DMD, PC was a registered Dentist - General Practice practicing in Wilsonville, OR. Throughout an active medical career spanning 15 years, Dr. Johnsen provided care at the practice location at 29990 SW TOWN CENTER LOOP W SUITE A until profile deactivation on 2023-09-27.

Practice Location & Contact Primary Location

Practice Address

29990 Sw Town Center Loop W Suite A

Wilsonville, OR 97070

Telephone 5036822110
Fax 5036828951
Associated Practice Facility / Clinic
🏢 Mack S Johnsen Dmd Pc Facility NPI 1346417748

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Wilsonville, OR

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 13.7 Yrs
Regional Practice Density
11 Specialists

Practicing in Wilsonville, OR (1994 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License OR 4949

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Dr. Denise Gates , DMD

Dentist - General Practice

NPI 1821497132

Doctor of Dental Medicine

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated September 27, 2023

Record deactivated on September 27, 2023

NPI Profile Active April 01, 2008

NPI status registered as active in NPPES database

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Updated Practice Location April 01, 2008

Registered at 29990 SW TOWN CENTER LOOP W SUITE A, WILSONVILLE, OR 97070 (Tel: 5036822110)

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Updated Business Mailing Address April 01, 2008

Registered at 29990 SW TOWN CENTER LOOP W SUITE A, WILSONVILLE, OR 970709425 (Tel: 5036822110)

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Provider Name / Credentials Updated April 01, 2008

Recorded as MACK JOHNSEN, DMD, PC

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Medical Taxonomy / Specialty Registered (Primary Specialty) April 01, 2008

Dentist (License #4949 in OR)

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Initial NPI Registration & Enumeration April 01, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1205008034
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 01, 2008
Last Update: April 01, 2008
Deactivation Date: September 27, 2023

Mailing Address

29990 Sw Town Center Loop W Suite A

Wilsonville, OR 970709425

Phone: 5036822110

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.