Dwight Hood Johnson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12052 Issued in MO

Practice address

430 W Independence St
Jackson, MO 63755-1203

Phone

(573) 243-3957

Fax

(573) 243-0076

NPI assigned

Nov 21, 2006

Sex

Male

Sole proprietor

Yes

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 MO

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

State licenses

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295800712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 W INDEPENDENCE ST",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637551203",
            "telephone_number": "573-243-3957",
            "fax_number": "573-243-0076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 W INDEPENDENCE ST",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637551203",
            "telephone_number": "573-243-3957",
            "fax_number": "573-243-0076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DWIGHT",
        "middle_name": "HOOD",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "12052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson Physical Therapy & Rehabilitation, Inc.
• Jackson Primary Care LLC
• Jackson Primary Care LLC
• Jackson R-2 Schools
• Stephanie Jansen, DC
• Jones Drug Store Inc
• Jones Drug Store Inc
• Jones Drug Store Inc
• Abigail Renae Kasten, DPT
• Kelsey Leeann Kasten

• General Practice Dentistry in Jackson, MO
• Providers in Jackson, MO by specialty
• General Practice Dentistry in Missouri

• 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.
• 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.