Robert W. Johansen, D.D.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

50 054893 Issued in NY

Practice address

5000 Menaul Blvd NE Ste B
Albuquerque, NM 87110-3046

Phone

(614) 425-1381

NPI assigned

Jun 8, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

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": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411948800000",
    "number": "1669675385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4777 TRAMWAY BLVD NE",
            "address_2": "APT 607",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871112974",
            "telephone_number": "614-425-1381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 MENAUL BLVD NE STE B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871103046",
            "telephone_number": "614-425-1381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "ROBERT",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-08",
        "last_updated": "2014-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "50 054893",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.022825",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CO",
            "license": "DEN.00202093",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Joh, MD
• Pritpal Johal, DMD
• Ellen Storm Johannsen, MS
• Garrett Johannsen, DDS
• Cheryl Lee Ann Johansen, LADAC
• Annika Johansson
• Trintje Johansson, DO
• John E. Dugie II, D.C., P.C. (Dugie Chiropractic)
• John M Wilson MD P C
• John M. Cornali, DDS, P.C.

• Orthodontics and Dentofacial Orthopedics Dentistry in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.

Verify at the official NPI Registry.