Joel Micah Johnson, DDS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

12011754A Issued in IN

Practice address

10211 Dupont Circle Dr W Ste a
Fort Wayne, IN 46825-1625

Phone

(260) 489-8989

Fax

(734) 763-8100

NPI assigned

Oct 15, 2012

Last updated

Oct 7, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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": "1350259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412640000000",
    "number": "1568714590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10211 DUPONT CIRCLE DR W STE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251625",
            "telephone_number": "260-489-8989",
            "fax_number": "734-763-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10211 DUPONT CIRCLE DR W STE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251625",
            "telephone_number": "260-489-8989",
            "fax_number": "734-763-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JOEL",
        "middle_name": "MICAH",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-15",
        "last_updated": "2014-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020824",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IN",
            "license": "12011754A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Johnson, RN
• Jaima Kay Johnson
• Jakiya Johnson
• Jayda Johnson
• Jennifer Lynne Johnson, AAHCC
• Josie Lyn Johnson, SLP
• Kelsey Johnson
• Keyundrea Johnson
• Kirby Johnson, FNP-BC
• Laci Johnson, M.S.ED.

• Orthodontics and Dentofacial Orthopedics Dentistry in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; 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.