Jacob Reece Johnson, DDS, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

7636 Issued in LA

Practice address

3839 W Congress St Ste B
Lafayette, LA 70506-6000

Phone

(870) 826-1511

NPI assigned

Jan 3, 2025

Sex

Male

Sole proprietor

Yes

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

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1735862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735862400000",
    "number": "1699584755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3839 W CONGRESS ST STE B",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705066000",
            "telephone_number": "870-826-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3839 W CONGRESS ST STE B",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705066000",
            "telephone_number": "870-826-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACOB",
        "middle_name": "REECE",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-01-03",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "LA",
            "license": "7636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delana Adiyah Janee Johnson, B.S
• Demetra Johnson
• Elonn Johnson
• Essence M Johnson
• Halie Elizabeth Johnson, BCBA
• Jasmine Renee' Johnson, MS, PLPC
• Jeffrey Lewis Johnson, CRNA
• Jonah Mason Johnson, P.T.
• Kelsey Johnson
• Kendra Johnson

• Orthodontics and Dentofacial Orthopedics Dentistry in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; 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.