Active NPI
Michael Bruce Johnston, DDS, MS
- Pediatric Dentistry
- Russellville, AR
National Provider Identifier
1649347634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 2643
- Practice address
- 1610 W C PL
Russellville, AR 72801-2705 - Phone
- (479) 968-8338
- Fax
- (479) 968-1688
- NPI assigned
- Nov 29, 2006
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 2643 | AR | Primary |
Addresses
Primary practice location
1610 W C PL
Russellville, AR 72801-2705
Mailing address
1610 W C PL
Russellville, AR 72801-2705
Phone (479) 968-8338
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 56547 | Other | AR | BLUE CROSS PROVIDER # |
| 545063 | Other | AZ | UNITED CONCORDIA PROV # |
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
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2643 | AR | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DRS Johnston & Richardson | Pediatric Dentistry | Past | Accepting new patients |
| DRS. Johnston & Lawrence | Pediatric Dentistry | Past | 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 and National Provider Directory roles.
-
- Pediatric Dentistry
- Russellville, AR
- NPI 1073688131
-
- Pediatric Dentistry
- Russellville, AR
- NPI 1265825004
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1649347634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1610 W C PL",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728012705",
"telephone_number": "479-968-8338",
"fax_number": "479-968-1688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1610 W C PL",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728012705",
"telephone_number": "479-968-8338",
"fax_number": "479-968-1688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTON",
"first_name": "MICHAEL",
"middle_name": "BRUCE",
"name_prefix": "Mr.",
"credential": "DDS, MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-29",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "AR",
"license": "2643",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PROVIDER #",
"identifier": "56547",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA PROV #",
"identifier": "545063",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.