Gary Robert Johnson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

29606 Issued in CA

Practice address

4910 Van Nuys Blvd.
Suite 202
Sherman Oaks, CA 91403-1760

Phone

(818) 981-4824

Fax

(818) 981-4096

NPI assigned

Sep 22, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gary Robert Johnson, DDS, Inc.

  • General Practice Dentistry
  • Sherman Oaks, CA
  • NPI 1134221880
  NPD (past) Authorized official

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1023117173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4910 VAN NUYS BLVD.",
            "address_2": "SUITE 202",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914031760",
            "telephone_number": "818-981-4824",
            "fax_number": "818-981-4096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4910 VAN NUYS BLVD.",
            "address_2": "SUITE 202",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914031760",
            "telephone_number": "818-981-4824",
            "fax_number": "818-981-4096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "GARY",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "29606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joey Brett MD a Professional Medical Corporation
• John a. Beradino, PH.D, Inc.
• John E. Glassco, MD, Inc.
• Elizabeth Ann John, M.A., CCC-SLP
• Ashley L Johnson
• Kaelyn K Johnson
• Margaret Ann Johnson, MFT
• Patricia Diane Johnson, PSY.D., MFT
• Patti Lee Johnson, LICENSED CLINICAL PS
• Sabree Krista Yvonne Johnson

• General Practice Dentistry in Sherman Oaks, CA
• Providers in Sherman Oaks, 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.