NPIMap

Organization Active NPI

Bryan D. Johnson, DDS, PA

  • General Practice Dentistry
  • Madison Lake, MN
National Provider Identifier
1043208267
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9815 Issued in MN
Legal business name
BRYAN D. JOHNSON, DDS, PA
Practice address
516 Main Street
Madison Lake, MN 56063
Phone
(507) 243-3747
Fax
(507) 243-3866
NPI assigned
Oct 11, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Bryan D. Johnson, DDSNPI 1891859112
Title
Dentist
Phone
(507) 243-3747

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D9815 MN Primary

Addresses

Primary practice location

516 Main Street
Madison Lake, MN 56063

Mailing address

PO Box 458
Madison Lake, MN 56063-0458
Phone (507) 243-3747

Other identifiers 1

IdentifierTypeStateIssuer
41321JOOtherMNBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043208267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 458",
            "city": "MADISON LAKE",
            "state": "MN",
            "postal_code": "560630458",
            "telephone_number": "507-243-3747",
            "fax_number": "507-243-3866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 MAIN STREET",
            "city": "MADISON LAKE",
            "state": "MN",
            "postal_code": "56063",
            "telephone_number": "507-243-3747",
            "fax_number": "507-243-3866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN D. JOHNSON, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "507-243-3747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D9815",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "41321JO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison Lake, MN

Sources for this page

  • 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.