NPIMap

Organization Active NPI

Gary R. Johnson, D.D.S., P.C.

Doing business as Berkeley Dental Clinic

  • Dental Clinic/Center
  • Berkeley, IL
National Provider Identifier
1366466930
Registry record updated Oct 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
GARY R. JOHNSON, D.D.S., P.C.
Doing business as
Berkeley Dental Clinic
Practice address
5646 Saint Charles Rd
Suite C
Berkeley, IL 60163-1148
Phone
(708) 544-7474
NPI assigned
Jul 27, 2006
Last updated
Oct 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2015

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

Authorized official

Name
Dr. Gary Robert Johnson, D.D.S.NPI 1649294927
Title
President
Phone
(708) 544-7474

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

5646 Saint Charles Rd
Suite C
Berkeley, IL 60163-1148

Mailing address

5646 Saint Charles Rd
Suite C
Berkeley, IL 60163-1148
Phone (708) 544-7474

Other names 1

  • Berkeley Dental Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445817600000",
    "number": "1366466930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5646 SAINT CHARLES RD",
            "address_2": "SUITE C",
            "city": "BERKELEY",
            "state": "IL",
            "postal_code": "601631148",
            "telephone_number": "708-544-7474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5646 SAINT CHARLES RD",
            "address_2": "SUITE C",
            "city": "BERKELEY",
            "state": "IL",
            "postal_code": "601631148",
            "telephone_number": "708-544-7474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY R. JOHNSON, D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2015-10-26",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-544-7474",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Berkeley Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berkeley, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2015; 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.