| NPI | 1356426050 |
|---|---|
| Former Legal Business Name | JOHN MAGNUSSON |
| Entity Type | Organization |
| Authorized Contact | JAIME L. BUCHOLTZ Office Manager 262-246-6486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2023-08-28 |