MEDICARE: DR. JOHN WILLIAM DAHLIE DDS

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	122300000X	Dentist	2526	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164640066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WILLIAM DAHLIE DDS

Provider Business Mailing Address
First Line	:	106 W 5TH ST
Second Line	:
City	:	SHAWANO
State	:	WI
Zip	:	54166
Country	:	US
Telephone Number	:	715-524-4913
Fax Number	:	715-524-6736

Provider Business Practice Location Address
First Line	:	106 W 5TH ST
Second Line	:
City	:	SHAWANO
State	:	WI
Zip	:	54166
Country	:	US
Telephone Number	:	715-524-4913
Fax Number	:	715-524-6736

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	03/15/2026

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