Active NPI
Johnny Roman Vidic, DDS
- Prosthodontics
- Fort Stewart, GA
National Provider Identifier
1366452526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 13776
- Practice address
- 351 West 6TH Street, BLDG 440
USA Dentac - Attn: Credentials
Fort Stewart, GA 31314-4704 - Phone
- (912) 767-6735
- Fax
- (912) 870-6735
- NPI assigned
- Aug 9, 2006
- Last updated
- May 13, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 13776 | MD | Primary |
Addresses
Primary practice location
351 West 6TH Street, BLDG 440
USA Dentac - Attn: Credentials
Fort Stewart, GA 31314-4704
Mailing address
351 West 6TH Street, BLDG 440
USA Dentac - Attn: Credentials
Fort Stewart, GA 31314-4704
Phone (912) 767-6735
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13776 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463097600000",
"number": "1366452526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "351 WEST 6TH STREET, BLDG 440",
"address_2": "USA DENTAC - ATTN: CREDENTIALS",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "313144704",
"telephone_number": "912-767-6735",
"fax_number": "912-870-6735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "351 WEST 6TH STREET, BLDG 440",
"address_2": "USA DENTAC - ATTN: CREDENTIALS",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "313144704",
"telephone_number": "912-767-6735",
"fax_number": "912-870-6735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDIC",
"first_name": "JOHNNY",
"middle_name": "ROMAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2016-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "MD",
"license": "13776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Stewart, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.