Robert Alexander Johnson, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D14071 Issued in MN

Practice address

927 Trettel LN
Cloquet, MN 55720

Phone

(218) 879-1227

Fax

(218) 878-2168

NPI assigned

Jun 25, 2018

Sex

Male

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: 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

Locations

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

• Lake Superior Dental Associates

  • General Practice Dentistry
  • Duluth, MN
  • NPI 1871672584
  Medicare reassignment NPD
• Sla Dental PLLC

  • General Practice Dentistry
  • Duluth, MN
  • NPI 1669894705
  NPD (past)

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534809600000",
    "number": "1093200826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 E 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052402",
            "telephone_number": "218-728-6445",
            "fax_number": "218-724-7003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 TRETTEL LN",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "55720",
            "telephone_number": "218-879-1227",
            "fax_number": "218-878-2168"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1225 E 1st St",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558052402",
            "country_code": "US",
            "telephone_number": "218-728-6445",
            "fax_number": "218-724-7003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ROBERT",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-25",
        "last_updated": "2018-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margarita York Jesme, DNP, APRN, FNP-C
• Jeffrey James Johnson, DDS
• Karen Marie Johnson, PT
• Kristy Johnson, LADC
• Rhonda J Johnson, PT
• Timothy Johnson
• Tina Marie Johnson
• Joie Ann Miletich
• Katie Mae Jorgensen, FNP
• Laurie L Kelley

• Dentist in Cloquet, MN
• Providers in Cloquet, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; 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.