Active NPI
Cole Johnson
- Endodontics
- Marion, IN
National Provider Identifier
1093384687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 12013639A
- Practice address
- 2017 S Western Ave
Marion, IN 46953-2824 - Phone
- (317) 910-2089
- NPI assigned
- Jun 18, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 12013639A | IN | Primary |
Addresses
Primary practice location
2017 S Western Ave
Marion, IN 46953-2824
Mailing address
2234 Woodcreek Dr
Avon, IN 46123-8096
Phone (317) 910-2089
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12013639A | IN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782777600000",
"number": "1093384687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2234 WOODCREEK DR",
"city": "AVON",
"state": "IN",
"postal_code": "461238096",
"telephone_number": "317-910-2089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2017 S WESTERN AVE",
"city": "MARION",
"state": "IN",
"postal_code": "469532824",
"telephone_number": "317-910-2089"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "COLE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-18",
"last_updated": "2026-06-30",
"certification_date": "2026-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "IN",
"license": "12013639A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marion, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.