Michael Wayne Johnson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12074 Issued in MN

Practice address

8559 Edinbrook Pkwy
Brooklyn Park, MN 55443-3747

Phone

(763) 425-3644

Fax

(763) 425-0953

NPI assigned

Dec 13, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659432664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13440 UPLANDER ST NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043959",
            "telephone_number": "612-862-7751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8559 EDINBROOK PKWY",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554433747",
            "telephone_number": "763-425-3644",
            "fax_number": "763-425-0953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MICHAEL",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jmkay Health Care Services Inc
• Jo G Theisen DC, PA (Family Chiropractic Health Service)
• Colette Rae Johnson, RN
• Katie Lyn Jensen Johnson, MA, LMFT
• Marissa Johnson
• Sao Slober Johnson
• Terrell Gayperail Johnson, LICSW
• Arianne Johnston
• Kelsey Stella Jonason
• Chris M Jones, PA-C

• General Practice Dentistry in Brooklyn Park, MN
• Providers in Brooklyn Park, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.