Individual
DR. RICHARD MATHIAS JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1507 TOWER AVE, RM 427, SUPERIOR, WI 54880
(715) 394-5792
Mailing address
1507 TOWER AVE, RM 427, SUPERIOR, WI 54880
(715) 394-5792
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5000864015
WI
122300000X
Dentist
D7559
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33674700
—
WI
01
—
90951JO
BCBS
—
Enumeration date
06/15/2006
Last updated
07/08/2007
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