Individual provider Active NPI

Warren C. Johnson, DDS

  • General Practice Dentistry
  • Meriden, CT
National Provider Identifier
1154424588
Registry record updated Feb 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13862 Issued in CT
Practice address
134 State St
Meriden, CT 06450-3293
Phone
(203) 237-2229
Fax
(203) 686-1677
NPI assigned
Sep 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901009874 MI
General Practice Dentistry 1223G0001X 13862 CT Primary

Addresses

Primary practice location

134 State St
Meriden, CT 06450-3293

Mailing address

2424 Puritan St
Detroit, MI 48238-1490
Phone (313) 861-5759

Other practice location 1

2424 Puritan St
Detroit, MI 48238-1490
Phone (313) 861-5759

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20240227001725 CT Practitioner - Dentist 3375988611 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13862CTMDGeneral Practice Dentistry
2901009874MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center Inc General Practice Current Accepting new patients
Community Health Center Inc CurrentSince Mar 1, 2024 Accepting new patients

Locations

134 State St
Meriden, CT 06450
Phone (203) 237-2229

19 Grand St
Middletown, CT 06457
Phone (860) 323-0172

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1154424588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2424 PURITAN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482381490",
            "telephone_number": "313-861-5759",
            "fax_number": "313-861-5794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 STATE ST",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064503293",
            "telephone_number": "203-237-2229",
            "fax_number": "203-686-1677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2424 Puritan St",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482381490",
            "country_code": "US",
            "telephone_number": "313-861-5759",
            "fax_number": "313-861-5794",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "WARREN",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901009874",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "13862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meriden, CT

Sources for this page

Verify at the official NPI Registry.