NPIMap

Organization Active NPI

Paducah Pediatric Dentistry PSC

  • Pediatric Dentistry
  • Paducah, KY
National Provider Identifier
1295740926
Registry record updated Apr 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
4218 Issued in KY
Legal business name
PADUCAH PEDIATRIC DENTISTRY PSC
Practice address
2850 Lone Oak Rd
Suite 1
Paducah, KY 42003-8043
Phone
(270) 554-3131
Fax
(270) 554-0124
NPI assigned
Jul 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2008

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

Authorized official

Name
Dr. James Dennis Johnston, D.D.S.NPI 1346491313
Title
President
Phone
(270) 554-3131

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 4218 KY
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 4218 KY Primary

Addresses

Primary practice location

2850 Lone Oak Rd
Suite 1
Paducah, KY 42003-8043

Mailing address

2850 Lone Oak Rd
Suite 1
Paducah, KY 42003-8043
Phone (270) 554-3131

Other identifiers 2

IdentifierTypeStateIssuer
60042181MedicaidKY
45002524MedicaidKY

Other names 1

  • J.D. Johnston PSC Former legal business name

National Provider Directory

National Provider Directory

Locations

1640 McCracken Blvd
Paducah, KY 42001
Phone (270) 534-5128

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1295740926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 LONE OAK RD",
            "address_2": "SUITE 1",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420038043",
            "telephone_number": "270-554-3131",
            "fax_number": "270-554-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 LONE OAK RD",
            "address_2": "SUITE 1",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420038043",
            "telephone_number": "270-554-3131",
            "fax_number": "270-554-0124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PADUCAH PEDIATRIC DENTISTRY PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "DENNIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "270-554-3131",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "KY",
            "license": "4218",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "4218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60042181",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45002524",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "J.D. Johnston PSC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Paducah, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; 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.