S. Shaun Johanson DDS, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40838 Issued in CA

Legal business name

S. SHAUN JOHANSON DDS, INC.

Practice address

1661 Pickett Rd
McKinleyville, CA 95519-3914

Phone

(707) 839-3227

NPI assigned

Mar 7, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. S Shaun Johanson, DDSNPI 1295866804

Title

Owner

Phone

(707) 839-3227

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• S Shaun Johanson, DDS

  • General Practice Dentistry
  • McKinleyville, CA
  • NPI 1295866804
  NPD (past) Authorized official
• Lawrence Gunnar Johanson, D.D.S.

  • General Practice Dentistry
  • McKinleyville, CA
  • NPI 1467505271
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003947623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2368",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955192368",
            "telephone_number": "707-839-3227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 PICKETT RD",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955193914",
            "telephone_number": "707-839-3227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S. SHAUN JOHANSON DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHANSON",
        "authorized_official_first_name": "S",
        "authorized_official_middle_name": "SHAUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-839-3227",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "40838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTICAL",
            "identifier": "B40838-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zachary Michael Roberts, LCSW
• Daniel Scott Robinson, RN
• Timothy Roettger
• Spencer Ian Ross
• Phillip K Ruprecht, O.D.
• Elwira Salata
• Melissa Salazar
• Laurie Goldberg Sanders, M.S., BCBA
• Karen Jean Santos, LCSW
• Sarah Cordero Physical Therapy Inc

• General Practice Dentistry in McKinleyville, CA
• Providers in McKinleyville, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.