Active NPI
Stephen Drannen Johnson, D.D.S.
- General Practice Dentistry
- Duluth, MN
National Provider Identifier
1730141458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D9082
- Practice address
- 324 W Superior St
Medical Arts Building Suite 930
Duluth, MN 55802-1701 - Phone
- (218) 727-5041
- Fax
- (218) 720-6974
- NPI assigned
- Apr 6, 2006
- Last updated
- Jul 8, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D9082 | MN | Primary |
Addresses
Primary practice location
324 W Superior St
Medical Arts Building Suite 930
Duluth, MN 55802-1701
Mailing address
324 W Superior St
Medical Arts Building Suite 930
Duluth, MN 55802-1701
Phone (218) 727-5041
Medicare participation
Medicare enrollment files- 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
- Opted out of Medicare
- Yes, effective Feb 2, 2016 through Feb 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D9082 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Miller Hill Dental PLLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730141458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "324 W SUPERIOR ST",
"address_2": "MEDICAL ARTS BUILDING SUITE 930",
"city": "DULUTH",
"state": "MN",
"postal_code": "558021701",
"telephone_number": "218-727-5041",
"fax_number": "218-720-6974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "324 W SUPERIOR ST",
"address_2": "MEDICAL ARTS BUILDING SUITE 930",
"city": "DULUTH",
"state": "MN",
"postal_code": "558021701",
"telephone_number": "218-727-5041",
"fax_number": "218-720-6974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "STEPHEN",
"middle_name": "DRANNEN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "D9082",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Duluth, MN
Sources for this page
- 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.
- 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.