Individual
DR. BRENT T JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1507 TOWER AVE, SUITE 202, SUPERIOR, WI 54880
(715) 394-3683
(715) 394-7315
Mailing address
3915 N 21ST ST, SUPERIOR, WI 54880
(715) 395-9954
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4772
WI
Other
Enumeration date
09/06/2006
Last updated
07/08/2007
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