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General NPI Number Information
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NPI Number | 1467530477
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Entity Type | Individual
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Provider Name | JOHN C MAGNUSSON DDS
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | N63W23524 SILVER SPRING DR
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City | SUSSEX
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State | WI
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Zip | 53089-3833
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Country | US
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Telephone | 262-246-6486
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Fax | 262-246-6791
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Provider Business Mailing Address
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Address Line | N63W23524 SILVER SPRING DR P O BOX 145
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City | SUSSEX
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State | WI
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Zip | 53089-3833
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Country | US
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Telephone | 262-246-6486
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Fax | 262-246-6791
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2354015
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License Number State | WI
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