Roger Edmund Johansen, D.M.D.

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

14977 Issued in NJ

Practice address

110 Bergen St
NJDS Room D 837
Newark, NJ 07103-2495

Phone

(973) 972-4526

NPI assigned

Mar 13, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457484115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 GREGORY AVE",
            "address_2": "A-105",
            "city": "WEEHAWKEN",
            "state": "NJ",
            "postal_code": "070865706",
            "telephone_number": "201-920-9026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BERGEN ST",
            "address_2": "NJDS ROOM D 837",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071032495",
            "telephone_number": "973-972-4526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "ROGER",
        "middle_name": "EDMUND",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NJ",
            "license": "14977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine S Jo, DMD
• Sebastien Joachim
• Joaquim J. Correia, MD LLC
• Joel Meer PC
• Johanan Care Inc.
• Elizabeth Johansson, CRNA
• George John, DO
• Miriam John, MD
• Zoneisha Johnson- Boswell, DNP, APN, FNP-BC
• Cheynya Johnson-Brimley, PA-C

• Prosthodontics in Newark, NJ
• Providers in Newark, NJ by specialty
• Prosthodontics in New Jersey

• 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.

Verify at the official NPI Registry.