Organization
EAU CLAIRE PERIODONTICS, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON D. JOHNSON D.D.S., M.S. (CHIEF MANAGER/PERIODONTIST)
(715) 832-5396
Entity
Organization
Contact information
Practice address
2125 HEIGHTS DR STE 2C, EAU CLAIRE, WI 54701-6146
(715) 832-5396
(715) 832-3009
Mailing address
2125 HEIGHTS DR STE 2C, EAU CLAIRE, WI 54701-6146
(715) 832-5396
(715) 832-3009
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
6810-015
WI
Other
Enumeration date
12/15/2011
Last updated
12/15/2011
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