NPIMap

Organization Active NPI

Keith D Johnson DDS PC

  • Dentist
  • Liberty, MO
National Provider Identifier
1164599452
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
14182 Issued in MO
Legal business name
KEITH D JOHNSON DDS PC
Practice address
26 S Village Drive
Liberty, MO 64068
Phone
(816) 781-7571
Fax
(816) 781-7933
NPI assigned
Nov 29, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Keith David Johnson, DDSNPI 1336330810
Title
General Dentist Owner
Phone
(816) 781-7571

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 14182 MO Primary

Addresses

Primary practice location

26 S Village Drive
Liberty, MO 64068

Mailing address

26 S Village Drive
Liberty, MO 64068
Phone (816) 781-7571

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164599452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 S VILLAGE DRIVE",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "64068",
            "telephone_number": "816-781-7571",
            "fax_number": "816-781-7933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 S VILLAGE DRIVE",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "64068",
            "telephone_number": "816-781-7571",
            "fax_number": "816-781-7933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH D JOHNSON DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "GENERAL DENTIST  OWNER",
        "authorized_official_telephone_number": "816-781-7571",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MO",
            "license": "14182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.