Tyler Russell Johansen, DMD, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DS039183 Issued in PA

Practice address

Naval Health Clinic Hawaii
480 Central Avenue
Pearl Harbor, HI 96860

Phone

(530) 276-3389

NPI assigned

Aug 1, 2012

Sex

Male

Sole proprietor

Yes

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

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1343779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1568718146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2379 POND RD",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967344851",
            "telephone_number": "530-276-3389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NAVAL HEALTH CLINIC HAWAII",
            "address_2": "480 CENTRAL AVENUE",
            "city": "PEARL HARBOR",
            "state": "HI",
            "postal_code": "96860",
            "telephone_number": "530-276-3389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "TYLER",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-01",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS039183",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "PA",
            "license": "DS039183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron L Jaks
• Benjamin Clarkson James, DPT
• Christopher John Jankosky, M.D.
• Nikole Marie Jeffries, LPN
• Justin Charles Jenks, R.N.
• James J Jones, LCDC
• Matthew Michael Justus, DO, MPH&TM
• Sandy Kaliko Kai, R.N.
• Arthur C. Kalfus, D.D.S.
• Kathy Kim Anderson Kam, R.N.

• Periodontics in Pearl Harbor, HI
• Providers in Pearl Harbor, HI by specialty
• Periodontics in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; 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.