Alfred Casburn Johnson Jr., DDS
Individual provider Active NPI General Practice Dentistry · York, SC
NPI 1215077433 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215077433
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3219 (SC)
- Practice address
- 1306 Old Fairhope CT
York, SC 29745 - Phone
- (803) 628-1142
- Fax
- (803) 628-5115
- NPI assigned
- Feb 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160322000796 | SC | Order and Referring Only - Dentist |
3173820958 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3219 | SC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reid Family Dental, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3219 | SC | Yes |
Addresses
Primary practice location
1306 Old Fairhope CT
York, SC 29745
Mailing address
PO Box 195
York, SC 29745-0195
Phone (803) 628-1142
Other providers in York, SC
- James-Olivereyecare,LLC
- Aleque Stegall James
- Jax & Rae Optometric
- JBM LLC
- Amy Ruth Jeffcoat
- Kimberly Johnson
- Jasmin Corvette Jones
- Ashley Jumper
- Laren C Keene
- Mary Gill Kennington
All providers in York, SC · General Practice Dentistry in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.