Provider Demographics
NPI:1952533465
Name:HOCHSTRASSER, JOHANN (DDS)
Entity Type:Individual
Prefix:
First Name:JOHANN
Middle Name:
Last Name:HOCHSTRASSER
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 1:1525 FAIRWAY LN
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-5000
Mailing Address - Country:US
Mailing Address - Phone:262-723-3296
Mailing Address - Fax:
Practice Address - Street 1:1525 FAIRWAY LN
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-5000
Practice Address - Country:US
Practice Address - Phone:262-723-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9333122300000X
WI10011321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500609371Medicaid