Individual
DR. SAMANTHA RYAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1624 HOBBS DR STE 2, DELAVAN, WI 53115-2000
(262) 740-1010
Mailing address
1624 HOBBS DR STE 2, DELAVAN, WI 53115-2000
(262) 740-1010
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1001830
WI
1223G0001X
General Practice Dentistry
Primary
1001830-15
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/01/2018
Last updated
06/08/2021
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