Provider Demographics
NPI:1477682086
Name:JOHNSON, LAWRENCE A (DDS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
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 1:1850 W POINTE DR
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-4164
Mailing Address - Country:US
Mailing Address - Phone:920-233-2222
Mailing Address - Fax:920-233-2263
Practice Address - Street 1:1850 W POINTE DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4164
Practice Address - Country:US
Practice Address - Phone:920-233-2222
Practice Address - Fax:920-233-2263
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001990-151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics