Corey Ivan Johnson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7486 Issued in CO

Practice address

2425 Grand Ave
Ste 109
Glenwood Springs, CO 81601-4180

Phone

(970) 945-9119

Fax

(970) 945-1065

NPI assigned

Oct 10, 2006

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215025101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 GRAND AVE",
            "address_2": "STE 109",
            "city": "GLENWOOD SPRINGS",
            "state": "CO",
            "postal_code": "816014180",
            "telephone_number": "970-945-9119",
            "fax_number": "970-945-1065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 GRAND AVE",
            "address_2": "STE 109",
            "city": "GLENWOOD SPRINGS",
            "state": "CO",
            "postal_code": "816014180",
            "telephone_number": "970-945-9119",
            "fax_number": "970-945-1065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "COREY",
        "middle_name": "IVAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "7486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edlin Jara-Molinar, PA
• Eric Jernigan, MD
• John M. Traul, DDS, PC
• Amy Johnson, PA
• Casey William Johnson, DDS
• Matthew Stephen Johnson, MD
• Teresa Maria Johnson, MD
• Kristin Johnston
• Jennifer Jones
• Aashish T. Kabra, M.D.

• All providers in Glenwood Springs, CO
• General Practice Dentistry in Colorado

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

Verify at the official NPI Registry.