Frederick Jeremy John, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

S6-140 Issued in NV

Practice address

4530 S Carson St Ste 5
Carson City, NV 89701-6914

Phone

(775) 461-3800

Fax

(775) 461-3801

NPI assigned

Jul 27, 2009

Sex

Male

Sole proprietor

No

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

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.

• Carson City Pediatric Dentistry, LLC

  • Dental Clinic/Center
  • Carson City, NV
  • NPI 1730486747
  NPD (past)
• CCPD LLC

  • Pediatric Dentistry
  • Carson City, NV
  • NPI 1134662679
  NPD (past)

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

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1356572226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 S CARSON ST STE 5",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897016914",
            "telephone_number": "775-461-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 S CARSON ST STE 5",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897016914",
            "telephone_number": "775-461-3800",
            "fax_number": "775-461-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN",
        "first_name": "FREDERICK",
        "middle_name": "JEREMY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-27",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NV",
            "license": "S6-140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Leigh Jensen, CPC-INTERN
• Ross M Jenson, M.D.
• Melissa Anne Jezek, PT
• Dulce Jimenez Cervantes
• John Paul Kelly
• Darla Johnson
• David Andrew Johnson, M.D.
• Diana Dee Johnson, RDO
• Jennifer K Johnson, LCPC
• Katie K Johnson, RPH, MA

• Pediatric Dentistry in Carson City, NV
• Providers in Carson City, NV by specialty
• Pediatric Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.