Mark W. Johnson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1527 Issued in NM

Practice address

5115 Coors Blvd NW Ste F
Albuquerque, NM 87120-1926

Phone

(505) 926-5160

Fax

(505) 792-4480

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635724800000",
    "number": "1023024536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5115 COORS BLVD NW STE F",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871201926",
            "telephone_number": "505-926-5160",
            "fax_number": "505-792-4480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 COORS BLVD NW STE F",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871201926",
            "telephone_number": "505-926-5160",
            "fax_number": "505-792-4480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARK",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "1527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "841521",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "85001",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Jaynes Johnson, LMFT
• Lori Johnson, SLP
• Makenna Johnson
• Maria Johnson, MD
• Mark Kevin Johnson
• Marla Johnson, STUDENT COUNSELOR
• Mary Johnson
• Mary Ellen Johnson
• Mary Ida Johnson, MD
• Mary Linda Johnson

• General Practice Dentistry in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; 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.