Andrew C Johnson, DDS, MDS, CDT

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

3960 Issued in AR

Practice address

3333 S Pinnacle Hills Pkwy Ste 140
Rogers, AR 72758-8953

Phone

(479) 755-3000

Fax

(479) 616-1914

NPI assigned

Nov 19, 2013

Sex

Male

Sole proprietor

No

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 8, 2016 through Mar 8, 2028

Medicare enrollment (NPD)

Not enrolled

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.

• Bold Dental Partners PLLC

  • Dentist
  • Fayetteville, AR
  • NPI 1619311198
  NPD (past)

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

{
    "created_epoch": "1384819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621209600000",
    "number": "1508296005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 S PINNACLE HILLS PKWY STE 140",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588953",
            "telephone_number": "479-755-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 S PINNACLE HILLS PKWY STE 140",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588953",
            "telephone_number": "479-755-3000",
            "fax_number": "479-616-1914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ANDREW",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DDS, MDS, CDT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-19",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "AR",
            "license": "3960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Jimenez
• Joe Hines Chiropractic, Inc.
• John a Huskins MD LLC
• Abbey Johnson
• Amanda Leigh Johnson, RN
• Brad Dale Johnson, MD
• Christopher S Johnson, MD
• Donna Dee Johnson, MD
• Felicity Johnson, MS, LPC
• Kearsten Nicole Johnson

• Prosthodontics in Rogers, AR
• Providers in Rogers, AR by specialty
• Prosthodontics in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.