Kirsten Marie Johnson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D13534 Issued in MN

Practice address

1380 Duckwood Dr
Suite 108
Eagan, MN 55123-1090

Phone

(651) 686-6500

Fax

(651) 686-7800

NPI assigned

Jun 11, 2015

Last updated

Jun 11, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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 MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433980800000",
    "number": "1033590369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 DUCKWOOD DR",
            "address_2": "SUITE 108",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551231090",
            "telephone_number": "651-686-6500",
            "fax_number": "651-686-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 DUCKWOOD DR",
            "address_2": "SUITE 108",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551231090",
            "telephone_number": "651-686-6500",
            "fax_number": "651-686-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KIRSTEN",
        "middle_name": "MARIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-11",
        "last_updated": "2015-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Sue Johnson, MA, LPCC
• Jeremiah David Johnson, M.D.
• Jerilyn Ann Johnson, PT
• Joshua Otis Johnson, PHARMD
• Joy Lynn Johnson, NP
• Lindsey Kaye Johnson, LMFT
• Lyndall Johnson, MA LP
• Mariah Kelley Johnson
• Melody B Johnson, PA-C
• Michelle Johnson

• General Practice Dentistry in Eagan, MN
• Providers in Eagan, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; 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.