Individual provider Active NPI

Donald J Johnson, DDS

  • General Practice Dentistry
  • Coeur d'Alene, ID
National Provider Identifier
1629153150
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D1677 Issued in ID
Practice address
114 W. Neider Ave.
Coeur D'Alene, ID 83815
Phone
(208) 667-4551
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D1677 ID Primary

Addresses

Primary practice location

114 W. Neider Ave.
Coeur D'Alene, ID 83815

Mailing address

114 W. Neider Ave.
Coeur D'Alene, ID 83815

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, WA2 enrollments
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.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110616000147 ID Practitioner - Oral Surgery 8628255890
I20260305002739 WA Practitioner - Dentist 8628255890 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
University of Minnesota School of Dentistry, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

850 W Maple St
PO Box 800
Medical Lake, WA 99022-5139

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D1677IDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Social Dept of SHS Div of Instns CurrentSince Jan 12, 2026 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529452800000",
    "number": "1629153150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 W. NEIDER AVE.",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "83815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 W. NEIDER AVE.",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "83815",
            "telephone_number": "208-667-4551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DONALD",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2018-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D1677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

Verify at the official NPI Registry.