Ken Johnson, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

4352 Issued in WI

Practice address

918 E Park Avenue PLZ
Beloit, WI 53511-1753

Phone

(608) 365-9456

NPI assigned

Nov 9, 2006

Sex

Male

Sole proprietor

Yes

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 WI

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

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331856000000",
    "number": "1124198924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "918 E PARK AVENUE PLZ",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111753",
            "telephone_number": "608-365-9456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 E PARK AVENUE PLZ",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111753",
            "telephone_number": "608-365-9456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KEN",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2012-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "4352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cindy L Johnson, LPN RCS
• Dawn M Johnson, CNP, DNP
• Diana Johnson, LPN
• Heather Johnson, LCSW
• Justin D. Johnson, OT
• Leighton C. Johnson Jr., MD
• Michael Blaine Johnson, LPC
• Nancy Moe Johnson, PA
• Ryleigh Johnson
• Jolly Counseling and Wellness LLC

• Dentist in Beloit, WI
• Providers in Beloit, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2012; 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.