Brent T Johnson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4772 Issued in WI

Practice address

1507 Tower Ave
Suite 202
Superior, WI 54880

Phone

(715) 394-3683

Fax

(715) 394-7315

NPI assigned

Sep 6, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifetime Dental, LLC

  • Dental Clinic/Center
  • Superior, WI
  • NPI 1487345922
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194828269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3915 N 21ST ST",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "54880",
            "telephone_number": "715-395-9954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 TOWER AVE",
            "address_2": "SUITE 202",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "54880",
            "telephone_number": "715-394-3683",
            "fax_number": "715-394-7315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRENT",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joan Kristen Jeanetta
• Joseph Frank Jeanetta
• Jennifer Hodgson Clinical Services LLC
• Ashley Elizabeth Jensen, FNP-BC
• Carole A. Jesberg, RN
• Karen Schwoebel Johnson, MS
• Lisa Marie Johnson, PTA
• Richard Mathias Johnson, DDS
• Sarah Elizabeth Johnson, PA-C
• Tiffany Johnson, C-SAC

• General Practice Dentistry in Superior, WI
• Providers in Superior, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.