Wesley Joseph Johnson, DDS
Individual provider Active NPI Dentist · Lakeland, TN
NPI 1154965549 · NPPES record last updated Jun 15, 2022
Key facts
- NPI
- 1154965549
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 11638 (TN)
- Practice address
- 8950 US Highway 64 Ste 108
Lakeland, TN 38002-4566 - Phone
- (901) 308-5952
- NPI assigned
- Oct 29, 2019
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
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 |
|---|---|---|---|
| 11638 | TN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memphis Dentures and Implants PLLC | Current |
Accepting new patients | |
| Mission Dental Mobile LLC | Dentist | Past |
Accepting new patients |
Locations
8950 US Highway 64
Ste 108
Lakeland, TN 38002
Phone (901) 308-5952
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11638 | TN | Yes |
Addresses
Primary practice location
8950 US Highway 64 Ste 108
Lakeland, TN 38002-4566
Mailing address
8950 US Highway 64 Ste 108
Lakeland, TN 38002-4566
Phone (901) 308-5952
Other providers in Lakeland, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2022. 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.