Marc Ernest Johnson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DE00009235 Issued in WA

Practice address

1407 Kresky Ave
Centralia, WA 98531-8912

Phone

(360) 736-9397

Fax

(360) 736-9397

NPI assigned

Oct 2, 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 WA

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

Practice roles

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.

• Duong Dai Ly PLLC.

  • General Practice Dentistry
  • Centralia, WA
  • NPI 1780590760
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154414084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 KRESKY AVE",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985318912",
            "telephone_number": "360-736-9397",
            "fax_number": "360-736-9397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 KRESKY AVE",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985318912",
            "telephone_number": "360-736-9397",
            "fax_number": "360-736-9397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARC",
        "middle_name": "ERNEST",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00009235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wanda Jimenez, M.D.M.P.H
• Darianne Renee Johnson
• Jennifer Jo Johnson
• Kaelene K Johnson
• Kristen Leigh Johnson, M.S., CF-SLP
• Tyneke Johnson
• Jenny Johnston Coleman, ARNP
• Rhea Johnstone, LSWAA
• Andrew Mark Jones
• Cecelie Jones

• Dentist in Centralia, WA
• Providers in Centralia, WA by specialty
• Dentist in Washington

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.