MEDICARE: JOHN C MAGNUSSON 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	1223G0001X	General Practice Dentistry	2354015	WI

General Provider Information

NPI Number	:	1467530477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN C MAGNUSSON DDS

Provider Business Mailing Address
First Line	:	N63W23524 SILVER SPRING DR
Second Line	:	P O BOX 145
City	:	SUSSEX
State	:	WI
Zip	:	53089-3833
Country	:	US
Telephone Number	:	262-246-6486
Fax Number	:	262-246-6791

Provider Business Practice Location Address
First Line	:	N63W23524 SILVER SPRING DR
Second Line	:
City	:	SUSSEX
State	:	WI
Zip	:	53089-3833
Country	:	US
Telephone Number	:	262-246-6486
Fax Number	:	262-246-6791

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/21/2022

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