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General NPI Number Information
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NPI Number | 1518538891
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Entity Type | Organization
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Legal Business Name | SENSATIONAL SMILES ORTHODONTICS LLC
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Dates
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Enumeration Date | 07/07/2021
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 106 WATSON ST
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City | RIPON
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State | WI
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Zip | 54971-1327
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Country | US
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Telephone | 920-748-7200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 419
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City | RIPON
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State | WI
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Zip | 54971
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Country | US
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Telephone | 920-748-7200
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Fax |
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Authorized Official
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Title or Position | OWNER/DDS
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Name | CHRISTOPHER G JOHNSON
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Credential | DDS
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Telephone | 920-748-7200
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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 |
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License Number State |
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