Active NPI
Keenon Johnson, DDS, MS
- Endodontics
- Raleigh, NC
National Provider Identifier
1659579647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 8669
- Practice address
- 10208 Cerny St
Suite 304
Raleigh, NC 27617-7884 - Phone
- (919) 706-0617
- Fax
- (919) 825-3361
- NPI assigned
- Jul 11, 2007
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 8669 | NC | Primary |
Addresses
Primary practice location
10208 Cerny St
Suite 304
Raleigh, NC 27617-7884
Mailing address
10208 Cerny St
Suite 304
Raleigh, NC 27617-7884
Phone (919) 706-0617
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 |
|---|---|---|---|
| 8669 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326153600000",
"number": "1659579647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10208 CERNY ST",
"address_2": "SUITE 304",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276177884",
"telephone_number": "919-706-0617",
"fax_number": "919-825-3361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10208 CERNY ST",
"address_2": "SUITE 304",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276177884",
"telephone_number": "919-706-0617",
"fax_number": "919-825-3361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KEENON",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-11",
"last_updated": "2012-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NC",
"license": "8669",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.