Jeffery Johnson, D.D.S.
Individual provider Active NPI Dentist · Potosi, MO
NPI 1346698396 · NPPES record last updated Jun 1, 2016
Key facts
- NPI
- 1346698396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2016017399 (MO)
- Practice address
- 1 Southtowne Dr
Potosi, MO 63664-5729 - Phone
- (573) 438-8401
- NPI assigned
- Jun 1, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2016017399 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Great Mines Health Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2016017399 | MO | Yes |
Addresses
Primary practice location
1 Southtowne Dr
Potosi, MO 63664-5729
Mailing address
5901 Colony Church Rd
Farmington, MO 63640-7424
Other providers in Potosi, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.