Active NPI
Milton Frederick Johanboeke Jr., D.M.D.
- General Practice Dentistry
- Madison, IN
National Provider Identifier
1497920656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12010214A
- Practice address
- 1105 Clifty Dr
Madison, IN 47250-1614 - Phone
- (812) 273-0207
- Fax
- (812) 273-3366
- NPI assigned
- Apr 28, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12010214A | IN | Primary |
Addresses
Primary practice location
1105 Clifty Dr
Madison, IN 47250-1614
Mailing address
1105 Clifty Dr
Madison, IN 47250-1614
Phone (812) 273-0207
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 |
|---|---|---|---|
| 12010214A | IN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209340800000",
"number": "1497920656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1105 CLIFTY DR",
"city": "MADISON",
"state": "IN",
"postal_code": "472501614",
"telephone_number": "812-273-0207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 CLIFTY DR",
"city": "MADISON",
"state": "IN",
"postal_code": "472501614",
"telephone_number": "812-273-0207",
"fax_number": "812-273-3366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHANBOEKE",
"first_name": "MILTON",
"middle_name": "FREDERICK",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-28",
"last_updated": "2008-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12010214A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.