Nancie J Johnson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

9836 Issued in MN

Practice address

18305 Minnetonka Blvd Ste 100
Deephaven, MN 55391

Phone

(952) 936-2206

Fax

(952) 936-0901

NPI assigned

Jun 20, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Mrs. Nancie J Petersen Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1467498485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18305 MINNETONKA BLVD STE 100",
            "city": "DEEPHAVEN",
            "state": "MN",
            "postal_code": "55391",
            "telephone_number": "952-936-2206",
            "fax_number": "952-936-0901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18305 MINNETONKA BLVD STE 100",
            "city": "DEEPHAVEN",
            "state": "MN",
            "postal_code": "55391",
            "telephone_number": "952-936-2206",
            "fax_number": "952-936-0901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NANCIE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "9836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INSURANCE CO",
            "identifier": "46554JO",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "9836",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA INSURANCE CO",
            "identifier": "4015051",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NANCIE",
            "last_name": "PETERSEN",
            "middle_name": "J",
            "prefix": "MRS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Dentist in Deephaven, MN
• Providers in Deephaven, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.