| Doctor Name: | DR. ROBERT A JOHANSEN |
| NPI Number: | 1609906908 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.D.S. |
| License Number: | 5000 647-015 |
| Business Practice Address: | 404 Wisconsin Ave Amery, WI - 540011058 |
| Business Phone Number: | 7152687177 |
| Business Fax Number: | 7152685716 |
| Mailing Address: | 404 Wisconsin Ave, AMERY |
| State: | WI |
| Postal Code: | 540011058 |
| Phone Number: | 7152687177 |
| Fax Number: | 7152685716 |
| NPI Enumeration Date: | 03/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223G0001X |
| License Number: | 5000 647-015 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | General Practice |
| Taxonomy Definition: | A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |