Active NPI
Mark Steven Johnson, DDS
- Dentist
- Annandale, MN
National Provider Identifier
1245388255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9649
- Practice address
- 93 Oak Avenue
3
Annandale, MN 55302-0539 - Phone
- (320) 274-2475
- Fax
- (320) 274-3152
- NPI assigned
- Jan 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9649 | MN | Primary |
Addresses
Primary practice location
93 Oak Avenue
3
Annandale, MN 55302-0539
Mailing address
93 Oak Avenue South
PO Box 539
Annandale, MN 55302-0539
Phone (320) 274-2475
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245388255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "93 OAK AVENUE SOUTH",
"address_2": "PO BOX 539",
"city": "ANNANDALE",
"state": "MN",
"postal_code": "553020539",
"telephone_number": "320-274-2475",
"fax_number": "320-274-3152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "93 OAK AVENUE",
"address_2": "3",
"city": "ANNANDALE",
"state": "MN",
"postal_code": "553020539",
"telephone_number": "320-274-2475",
"fax_number": "320-274-3152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MARK",
"middle_name": "STEVEN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "9649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Annandale, MN
Sources for this page
- 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.