Active NPI
Jack Johnston, DDS
- Dentist
- Kilgore, TX
National Provider Identifier
1598494239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 38441
- Practice address
- 5140 FM 1252 W
Kilgore, TX 75662-1961 - Phone
- (903) 983-1919
- NPI assigned
- Jun 8, 2022
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 38441 | TX | Primary |
Addresses
Primary practice location
5140 FM 1252 W
Kilgore, TX 75662-1961
Mailing address
5140 FM 1252 W
Kilgore, TX 75662-1961
Phone (903) 983-1919
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 |
|---|---|---|---|
| 38441 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654646400000",
"number": "1598494239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5140 FM 1252 W",
"city": "KILGORE",
"state": "TX",
"postal_code": "756621961",
"telephone_number": "903-983-1919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5140 FM 1252 W",
"city": "KILGORE",
"state": "TX",
"postal_code": "756621961",
"telephone_number": "903-983-1919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTON",
"first_name": "JACK",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-08",
"last_updated": "2022-06-08",
"certification_date": "2022-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "38441",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kilgore, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.