Four Corners Oral and Maxilliofacial Surgery

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

C36335 Issued in CO

Legal business name

FOUR CORNERS ORAL AND MAXILLIOFACIAL SURGERY

Practice address

72 Suttle St
S# E
Durango, CO 81303-6829

Phone

(970) 385-5432

Fax

(970) 385-5077

NPI assigned

Dec 13, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Michael Walter Johnson, M.D,DDSNPI 1811914344

Title

President

Phone

(970) 385-5432

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Walter Johnson, M.D. & DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Durango, CO
  • NPI 1811914344
  NPD (past) Authorized official

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

{
    "created_epoch": "1355356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355356800000",
    "number": "1104162452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 SUTTLE ST",
            "address_2": "S# E",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813036829",
            "telephone_number": "970-385-5432",
            "fax_number": "970-385-5077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 SUTTLE ST",
            "address_2": "S# E",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813036829",
            "telephone_number": "970-385-5432",
            "fax_number": "970-385-5077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR CORNERS ORAL AND MAXILLIOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-13",
        "last_updated": "2012-12-13",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "970-385-5432",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D,DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CO",
            "license": "C36335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Four Corners Mental Health, LLC
• Four Corners Naturopathic
• Four Corners Nephrology Associates PC
• Four Corners OB/GYN
• Four Corners Occupational Medicine Inc
• Four Corners Pharmacy, LLC
• Four Corners Psychiatry LLC
• Four Corners Smiles 4 Kids, Inc.
• Jonathan James Fox, MD
• Jonathan Raphael Fox, PA

• Dental Clinic/Center in Durango, CO
• Providers in Durango, CO by specialty
• Dental Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; 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.