Jason Johnson

Primary specialty

DentistTaxonomy code 122300000X

License

D12015 Issued in MN

Practice address

828 Hawthorne St E
Saint Paul, MN 55106-3252

Phone

(651) 774-2959

NPI assigned

Jan 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southdale Periodontics

  • Periodontics
  • Edina, MN
  • NPI 1326044538
  NPD (past)
• Southdale Periodontics, PLLC

  • Periodontics
  • Edina, MN
  • NPI 1134547730
  NPD (past)

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

{
    "created_epoch": "1138406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1285605287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4936 BIRCH LAKE CIR",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551106749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 HAWTHORNE ST E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551063252",
            "telephone_number": "651-774-2959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JASON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-28",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivy Johnson, LICSW
• Jaci Johnson, LCSW
• Jacquelyn Johnson, LMT
• James Edward Johnson
• Janice Mae Johnson, DC
• Jenna Johnson, MDT
• Jennifer Johnson
• Jennifer M Johnson, 1 CNP, DNP
• Jessica Johnson
• Joseph James Johnson, PT

• Dentist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.