MEDICARE: DR. RICHARD CHARLES JOHANNES D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2671	WI

General Provider Information

NPI Number	:	1407958093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD CHARLES JOHANNES D.D.S.

Provider Business Mailing Address
First Line	:	10134 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-5700
Country	:	US
Telephone Number	:	262-241-3500
Fax Number	:	262-241-0891

Provider Business Practice Location Address
First Line	:	10134 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-5700
Country	:	US
Telephone Number	:	262-241-3500
Fax Number	:	262-241-0891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. RICHARD CHARLES JOHANNES D.D.S.” Practice Location

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