Provider Demographics
NPI:1972526325
Name:DANIEL J. JOHANEK D.D.S.S.C.
Entity type:Organization
Organization Name:DANIEL J. JOHANEK D.D.S.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:JOHANEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-731-6416
Mailing Address - Street 1:2563 E CALUMET ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-4748
Mailing Address - Country:US
Mailing Address - Phone:920-731-1275
Mailing Address - Fax:
Practice Address - Street 1:2563 E CALUMET ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-4748
Practice Address - Country:US
Practice Address - Phone:920-731-1275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1314 G122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty