Individual
DR. ROBERT A JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
404 WISCONSIN AVE, AMERY, WI 54001-1058
(715) 268-7177
(715) 268-5716
Mailing address
404 WISCONSIN AVE, AMERY, WI 54001-1058
(715) 268-7177
(715) 268-5716
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5000 647-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3366 9200
WI MEDICAL ASSISTANCE
WI
Enumeration date
03/06/2007
Last updated
07/08/2007
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