Active NPI
Dennis Johnson, MD, PHD
- Clinical Molecular Genetics Physician
- SLC, UT
National Provider Identifier
1639585011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Molecular Genetics Physician
- License
- 033683
- Practice address
- 100 Mario Capecchi Dr
Dept. of Pathology
SLC, UT 84113-1103 - Phone
- (801) 662-2170
- NPI assigned
- Jul 7, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Molecular Genetics Physician | 207SG0203X | 033683 | CT | Primary |
Addresses
Primary practice location
100 Mario Capecchi Dr
Dept. of Pathology
SLC, UT 84113-1103
Mailing address
600 Warren Rd Apt 10-2F
Ithaca, NY 14850-1830
Phone (203) 824-4813
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
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 033683 | CT | MD | Clinical Molecular Genetics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404691200000",
"number": "1639585011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 WARREN RD APT 10-2F",
"city": "ITHACA",
"state": "NY",
"postal_code": "148501830",
"telephone_number": "203-824-4813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MARIO CAPECCHI DR",
"address_2": "DEPT. OF PATHOLOGY",
"city": "SLC",
"state": "UT",
"postal_code": "841131103",
"telephone_number": "801-662-2170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "DENNIS",
"credential": "MD, PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-07",
"last_updated": "2014-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "207SG0203X",
"taxonomy_group": "",
"desc": "Medical Genetics, Clinical Molecular Genetics",
"state": "CT",
"license": "033683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in SLC, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.