Provider Demographics
NPI:1063451359
Name:JOHNSON, STEVEN HARRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:HARRIS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 3RD ST
Mailing Address - Street 2:P.O. BOX 267
Mailing Address - City:PEPIN
Mailing Address - State:WI
Mailing Address - Zip Code:54759-9646
Mailing Address - Country:US
Mailing Address - Phone:715-442-2211
Mailing Address - Fax:715-442-2211
Practice Address - Street 1:715 3RD ST
Practice Address - Street 2:
Practice Address - City:PEPIN
Practice Address - State:WI
Practice Address - Zip Code:54759-9646
Practice Address - Country:US
Practice Address - Phone:715-442-2211
Practice Address - Fax:715-442-2211
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33426300Medicaid