Benjamin Aaron Johnson – General Practice Dentistry

Key facts

NPI: 1144458019
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 25262 (TX)
Practice address: 4000 Bellmead Dr
Waco, TX 76705
Phone: (254) 799-5461
Fax: (254) 799-1228
NPI assigned: Jun 30, 2009
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Acre Wood Dental Public Health Dentistry · Waco, TX · NPI 1912380650

NPD (past) DENTIST

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
25262	UT	MD	Dentist
25262	TX	MD	General Practice Dentistry
73833819922	UT	MD	General Practice Dentistry

Practice roles

Organization	Specialty	Status	New patients
Acre Wood Dental	Dentist	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist	122300000X	25262	UT
General Practice Dentistry	1223G0001X	73833819922	UT
General Practice Dentistry	1223G0001X	25262	TX	Yes

Addresses

Primary practice location

4000 Bellmead Dr
Waco, TX 76705

Mailing address

4000 Bellmead Dr
Waco, TX 76705
Phone (254) 799-5461

Other providers in Waco, TX

All providers in Waco, TX · General Practice Dentistry in Texas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2021. 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.

Verify at the official NPI Registry.