J Terry Johnson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5907 Issued in IA

Practice address

427 E Kanesville Blvd
Suite 306
Council Bluffs, IA 51503-4403

Phone

(712) 328-1885

NPI assigned

Feb 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IA

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1639143316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 E KANESVILLE BLVD",
            "address_2": "SUITE 306",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034403",
            "telephone_number": "712-328-1885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 E KANESVILLE BLVD",
            "address_2": "SUITE 306",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034403",
            "telephone_number": "712-328-1885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "J TERRY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "5907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0119693",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John M. Ippolito MD, P.C
• Samantha Joylynn John, PTA
• Kevin C Johns, LPTA
• Bergan Jayde Johnsen, PTA
• Teresa A Johnsen, CCC-SLP
• Jill Marie Johnson, LMHC, LMHP
• Lynette Johnson
• Molly Beth Johnson, APRN
• Tammy Marie Johnson, ARNP
• Wendy Marie Johnson, P.A.-C.

• General Practice Dentistry in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• General Practice Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.