Provider Demographics
NPI:1639794837
Name:JOHNSON, SYDNEY ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:ELIZABETH
Other - Last Name:CYZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6625 W BLUEMOUND RD APT 5
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3973
Mailing Address - Country:US
Mailing Address - Phone:920-217-3991
Mailing Address - Fax:
Practice Address - Street 1:14061 SAINT FRANCIS BLVD
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-4692
Practice Address - Country:US
Practice Address - Phone:763-576-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14369122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist