Johnson, Amber Marissa
Johnson, Amber Marissa is an individual health care provider with primary practice located at 450 Old Abe Rd , Lac Du Flambeau WI 54538-9682. She recently has only one registered license in Dental Providers / Dental Hygienist, which is considered as her primary health care specialty. Johnson, Amber Marissa can be contacted via phone (715) 588-4280.Contact Information
Primary practice address
450 Old Abe Rd
Lac Du Flambeau WI 54538-9682
Phone: (715) 588-4280
Fax: (715) 588-2269
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dental Hygienist | 124Q00000X | 10210 | Wisconsin |
Profile Details
| NPI number | 1912169855 |
|---|---|
| LBN Legal business name | Johnson, Amber Marissa |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 1st, 2008 |
| Last updated | Jul 1st, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912169855 | NPPES |
| Wisconsin | MEDICAID | 33822000 |
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