Active NPI
Douglas Scott Johansen, DDS
- Dentist
- Hartford, MI
National Provider Identifier
1366571200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901018068
- Practice address
- 57418 County Road 681
Hartford, MI 49057-9421 - Phone
- (269) 621-3143
- NPI assigned
- Mar 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2901018068 | MI | Primary |
Addresses
Primary practice location
57418 County Road 681
Hartford, MI 49057-9421
Mailing address
2611 S Cleveland Ave
Saint Joseph, MI 49085-3001
Phone (269) 408-1225
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 |
|---|---|---|---|
| 2901018068 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366571200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2611 S CLEVELAND AVE",
"city": "SAINT JOSEPH",
"state": "MI",
"postal_code": "490853001",
"telephone_number": "269-408-1225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "57418 COUNTY ROAD 681",
"city": "HARTFORD",
"state": "MI",
"postal_code": "490579421",
"telephone_number": "269-621-3143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHANSEN",
"first_name": "DOUGLAS",
"middle_name": "SCOTT",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901018068",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hartford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.