Jeffrey C. Johnson, D.D.S.
Individual provider Active NPI General Practice Dentistry · Hagatna, GU
NPI 1114570652 · NPPES record last updated Jul 23, 2019
Key facts
- NPI
- 1114570652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D829 (GU)
- Practice address
- 250 Route 4 Ste 101
Hagatna, GU 96910-7110 - Phone
- (671) 646-7982
- Fax
- (671) 646-7989
- NPI assigned
- Jul 23, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D829 | GU | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D829 | GU | Yes |
Addresses
Primary practice location
250 Route 4 Ste 101
Hagatna, GU 96910-7110
Mailing address
250 Route 4 Ste 101
Hagatna, GU 96910-7110
Phone (671) 646-7982
Other practice location 1
250 Route 4 Ste 101
Hagatna, GU 96910-7110
Phone (671) 646-7982
Other practice location 2
250 Route 4 Ste 101
Hagatna, GU 96910-7110
Phone (671) 646-7982
Other providers in Hagatna, GU
- Haddock Health, PC
- Carla Torres Haddock
- Haganta Clinic, PC
- Ideal Vision Center LLC
- Jeffrey David Ives
- Ku in Kang
- Backhabwha Kim
- Gabrielle Kimura Lagutang
- Dianna M Le
- Kunsun Lee
All providers in Hagatna, GU · General Practice Dentistry in Guam
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.