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

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

GARY R. JOHNSON, D.D.S., P.C.

Practice address

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

Phone

(708) 544-7474

NPI assigned

Jul 27, 2006

Organization subpart

No

Name

Dr. Gary Robert Johnson, D.D.S.

Title

President

Phone

(708) 544-7474

• Berkeley Dental Clinic Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 26, 2015.

{
    "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"
        }
    ]
}

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• Mia Violetta Karoutsos, LMT, CMLD
• Michael a. Esposito DDS, P.C.

• All providers in Berkeley, IL
• Dental Clinic/Center in Illinois

• 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.