Provider Demographics
NPI:1316102940
Name:JOHNSON, LOWELL THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:THOMAS
Last Name:JOHNSON
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 1:6040 N KENT AVE
Mailing Address - Street 2:MARQUETTE UNIVERSITY SCHOOL OF DENTISTRY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4644
Mailing Address - Country:US
Mailing Address - Phone:414-332-8008
Mailing Address - Fax:
Practice Address - Street 1:6040 N KENT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-4644
Practice Address - Country:US
Practice Address - Phone:414-332-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4001695 - 015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist