John F Johnson III, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

043500NY Issued in NY

Practice address

277 Oriskany Blvd
Whitesboro, NY 13492

Phone

(315) 736-6456

Fax

(315) 736-3309

NPI assigned

Dec 13, 2006

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

Other names 1

• Dr. Jack Farla Johnson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Dec 22, 2015 through Dec 22, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124189998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 ORISKANY BLVD",
            "city": "WHITESBORO",
            "state": "NY",
            "postal_code": "13492",
            "telephone_number": "315-736-6456",
            "fax_number": "315-736-3309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 ORISKANY BLVD",
            "city": "WHITESBORO",
            "state": "NY",
            "postal_code": "13492",
            "telephone_number": "315-736-6456",
            "fax_number": "315-736-3309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JOHN",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "043500NY",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACK",
            "last_name": "JOHNSON",
            "middle_name": "FARLA",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Rebecca Hulser, LMHC
• Beverly Gene Ischia, FAMILY NURSE PRACTIT
• Theresa M Jedrysik, M.S., SPE. ED
• Kimberly Kathryn Jennings, OTR/L
• Jenean Nicole Jessen, LPN
• Thomas R Joslyn, LCSW
• Asima Kajtazovic, FNP
• Ashley Heryn Kim
• David Paul Kingwater II, D.C.
• Cristin Kirkland, FNP

• All providers in Whitesboro, NY
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.