Marc G Johnson, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

048311 Issued in NY

Practice address

500 N Main St
Canandaigua, NY 14424-1022

Phone

(585) 394-3322

Fax

(585) 394-1175

NPI assigned

Sep 16, 2006

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 29, 2016 through Apr 29, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Canandaigua Oral Surgery, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Canandaigua, NY
  • NPI 1922135920
  NPD (past)

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272326400000",
    "number": "1689770679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N MAIN ST",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144241022",
            "telephone_number": "585-394-3322",
            "fax_number": "585-394-1175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N MAIN ST",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144241022",
            "telephone_number": "585-394-3322",
            "fax_number": "585-394-1175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARC",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2010-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "048311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John O. Evans, O.D,
• Leyna Johnson Nguyen, LMSW, CASAC
• Kapri Johnson, DNP
• Karlee Johnson
• Lisa R. Johnson, CCC-SLP
• Marsha A Johnson, CDN
• Megan Sheila Johnson, AU.D.
• Stephanie Johnson
• Diane Lynn Johnston, LCSW-R
• Jonathan Grasso

• Oral and Maxillofacial Surgery (Dentist) in Canandaigua, NY
• Providers in Canandaigua, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.