Provider Demographics
NPI:1811057961
Name:JOHNSON, KAREN AGNETE (DDS)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:AGNETE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929
Mailing Address - Country:US
Mailing Address - Phone:715-823-2233
Mailing Address - Fax:715-823-5720
Practice Address - Street 1:112 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929
Practice Address - Country:US
Practice Address - Phone:715-823-2233
Practice Address - Fax:715-823-5720
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5325015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist