H a Johnson DDS Inc

Primary specialty

DentistTaxonomy code 122300000X

License

30-017934 Issued in OH

Legal business name

H A JOHNSON DDS INC

Practice address

2475 E 22ND St
Suite 204
Cleveland, OH 44115-3221

Phone

(216) 566-7770

Fax

(216) 566-7704

NPI assigned

May 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Henderson Andrew Johnson IV, D.D.S.NPI 1104994052

Title

President-Owner

Phone

(216) 566-7770

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Henderson Andrew Johnson IV, D.D.S

  • General Practice Dentistry
  • Cleveland, OH
  • NPI 1104994052
  NPD (past) Authorized official

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1326258476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2475 E 22ND ST",
            "address_2": "SUITE 204",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441153221",
            "telephone_number": "216-566-7770",
            "fax_number": "216-566-7704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2475 E 22ND ST",
            "address_2": "SUITE 204",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441153221",
            "telephone_number": "216-566-7770",
            "fax_number": "216-566-7704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "H A JOHNSON DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "HENDERSON",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT-OWNER",
        "authorized_official_telephone_number": "216-566-7770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-017934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0668406",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.