Matthew Jeffrey Johnson, MD, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

9900556 Issued in NC

Practice address

229 Medical Park Rd Suite 310
Mooresville, NC 28117-8522

Phone

(704) 799-0771

Fax

(704) 799-2941

NPI assigned

Sep 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Hero Ventures PLLC

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
  • NPI 1235476235
  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202428800000",
    "number": "1437240728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 MEDICAL PARK RD STE 310",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178544",
            "telephone_number": "704-799-0771",
            "fax_number": "704-799-2941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 MEDICAL PARK RD SUITE 310",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178522",
            "telephone_number": "704-799-0771",
            "fax_number": "704-799-2941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MATTHEW",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "MD, DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2008-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "9900556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "8742082",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891218U",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1218U",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5738691002",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA DENTAL",
            "identifier": "536660",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7082247",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DENTAL",
            "identifier": "89902HV",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chantel Vantrice Johnson
• Emily Lynne Johnson
• John Anthony Johnson, D.M.D., M.D.
• Kimberly L Johnson, NP
• Matthew Jeffrey Johnson Jr., MD
• Stephanie Nicole Johnson
• Andrew C Jones, RDN, LDN
• Jennifer W Jones, DPT
• Natasha Nicole Jones, CNM
• Queneisha Jones, MSW, LCSW-A

• Oral and Maxillofacial Surgery (Dentist) in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2008; 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.