Timothy Terell Johnson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

3108-99 Issued in MS

Practice address

512 W Fulton St
Canton, MS 39046-4254

Phone

(601) 855-5885

Fax

(601) 855-2833

NPI assigned

Sep 14, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Canton Communitydentalclinicllc

  • General Practice Dentistry
  • Canton, MS
  • NPI 1568567477
  NPD (past) Authorized official

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316042237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 W FULTON ST",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390464254",
            "telephone_number": "601-855-5885",
            "fax_number": "601-855-2833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 W FULTON ST",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390464254",
            "telephone_number": "601-855-5885",
            "fax_number": "601-855-2833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TIMOTHY",
        "middle_name": "TERELL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3108-99",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0060251",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lashonda Latrice Johnson
• Margaret Regenia Johnson, LCSW
• Mary Ann Johnson, CFNP
• Relena Johnson
• Shelby Howard Johnson, M.S. PCMHT
• Dailyn Johnston, SLP
• Jones Family Chiropractic PA
• Angela Jones-Stewart, FNP-C
• Brittany Janae Jones, FNP
• Charles Brayden Jones, DPT

• Dentist in Canton, MS
• Providers in Canton, MS by specialty
• Dentist in Mississippi

• 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.

Verify at the official NPI Registry.