Dwight Layne Johnson, D.M.D., M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DE00010960 Issued in WA

Practice address

1129 S 2ND Ave Ste D
Walla Walla, WA 99362-4100

Phone

(509) 516-1200

Fax

(509) 516-1209

NPI assigned

Dec 29, 2005

Last updated

Sep 14, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jun 23, 2023 through Jun 23, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1043297153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 S 2ND AVE STE D",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624100",
            "telephone_number": "509-516-1200",
            "fax_number": "509-516-1209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 S 2ND AVE STE D",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624100",
            "telephone_number": "509-516-1200",
            "fax_number": "509-516-1209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DWIGHT",
        "middle_name": "LAYNE",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "ID",
            "license": "D-3382",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "UT",
            "license": "376097-9921",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": "DE00010960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Johnson, PHARM.D.
• Bobbiejo Jean Johnson
• Bradley Loyal Johnson, MD
• Cassandra Johnson
• Deborah Johnson, RPH
• Jeffrey A Johnson, LCPO
• Kayla Brooke Johnson, LMT
• Robert Johnson, MD00041003
• Robert Arnold Johnson, M.D.
• Robert L Johnson, DO

• Periodontics in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Periodontics in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.