Eau Claire Periodontics, L.L.C.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

6810-015 Issued in WI

Legal business name

EAU CLAIRE PERIODONTICS, L.L.C.

Practice address

2125 Heights Dr Ste 2C
Eau Claire, WI 54701-6146

Phone

(715) 832-5396

Fax

(715) 832-3009

NPI assigned

Dec 15, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Jason D. Johnson, D.D.S., M.S.

Title

Chief Manager/Periodontist

Phone

(715) 832-5396

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1323907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323907200000",
    "number": "1578832853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 HEIGHTS DR STE 2C",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547016146",
            "telephone_number": "715-832-5396",
            "fax_number": "715-832-3009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 HEIGHTS DR STE 2C",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547016146",
            "telephone_number": "715-832-5396",
            "fax_number": "715-832-3009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAU CLAIRE PERIODONTICS, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-15",
        "last_updated": "2011-12-15",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CHIEF MANAGER/PERIODONTIST",
        "authorized_official_telephone_number": "715-832-5396",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "WI",
            "license": "6810-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eau Claire Home Care LLC
• Eau Claire Medical Clinic, S.C.
• Eau Claire Medical Clinic, S.C.
• Eau Claire Metro Treatment Center
• Eau Claire Metro Treatment Center
• Eau Claire Psychologists LLC
• Eau Claire Refractive LLC
• Eau Claire Sober Living
• Eau Claire Spine & Orthopedics, SC
• Eau Claire Women'S Care S.C.

• Periodontics in Eau Claire, WI
• Providers in Eau Claire, WI by specialty
• Periodontics in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; 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.