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General NPI Number Information
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NPI Number | 1033283585
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Entity Type | Organization
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Legal Business Name | LAWRENCE A JOHNSON DDS SC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1850 WEST POINTE DRIVE
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City | OSHKOSH
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State | WI
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Zip | 54902-4164
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Country | US
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Telephone | 920-233-2222
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Fax | 920-233-2263
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Provider Business Mailing Address
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Address Line | 1850 WEST POINTE DRIVE
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City | OSHKOSH
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State | WI
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Zip | 54902-4164
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Country | US
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Telephone | 920-233-2222
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Fax | 920-233-2263
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Authorized Official
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Title or Position | PRESIDENT OF LAWRENCE A JOHNSON DDS
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Name | LAWRENCE A JOHNSON
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Credential | DDS
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Telephone | 920-233-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1990G
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License Number State | WI
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