Kenneth Wayne Johnson, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

PEDO29796 Issued in MS

Practice address

704 Hillcrest
Tupelo, MS 38804

Phone

(662) 840-8540

Fax

(662) 840-0629

NPI assigned

Oct 17, 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

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": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497836704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 MITTS DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388012215",
            "telephone_number": "662-840-8540",
            "fax_number": "662-840-0629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 HILLCREST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "38804",
            "telephone_number": "662-840-8540",
            "fax_number": "662-840-0629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENNETH",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MS",
            "license": "PEDO29796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James C Johnson Jr., MD
• Jordan Johnson
• Joy F Johnson
• Julianne Derise Johnson, BA
• Kemberly Johnson, PCCSS
• Lauren Johnson, DNP, CRNA
• Mareia Johnson
• Melissa Johnson
• Mollie McKay Johnson, AU.D., CCC-A
• Stella M. Johnson, LCSW

• Pediatric Dentistry in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Pediatric Dentistry in Mississippi

• 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.