Derek Lyle Johnson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6090 Issued in NV

Practice address

175 Brinkby Ave
Reno, NV 89509-4327

Phone

(775) 825-9225

NPI assigned

Jun 3, 2011

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

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": "1307059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307059200000",
    "number": "1043504384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 BRINKBY AVE",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895094327",
            "telephone_number": "775-825-9225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 BRINKBY AVE",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895094327",
            "telephone_number": "775-825-9225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DEREK",
        "middle_name": "LYLE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-03",
        "last_updated": "2011-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "6090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles E Johnson, M.D.
• Colton Johnson
• David Johnson, MD
• David Carl Johnson, M.D.
• Derek Johnson
• Gary Johnson, M.D.
• Gary M Johnson, PA-C
• Heidi Marie Johnson, MD
• Idris Johnson
• J Michael Johnson, DC

• General Practice Dentistry in Reno, NV
• Providers in Reno, NV by specialty
• General Practice Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2011; 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.