Kevin Bradley Johnson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3287 Issued in ID

Practice address

1310 Ponderosa Dr
Sandpoint, ID 83864-5073

Phone

(208) 263-7641

Fax

(208) 265-4333

NPI assigned

Sep 3, 2013

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

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.

• Kevin B. Johnson, DDS

  • Dentist
  • Sandpoint, ID
  • NPI 1568516714
  NPD (past) Authorized official
• Loftus Family Dental - Sandpoint PLLC

  • General Practice Dentistry
  • Sandpoint, ID
  • NPI 1497148860
  NPD (past)

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

{
    "created_epoch": "1378166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378857600000",
    "number": "1740615293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 PONDEROSA DR",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838645073",
            "telephone_number": "208-263-7641",
            "fax_number": "208-265-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 PONDEROSA DR",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838645073",
            "telephone_number": "208-263-7641",
            "fax_number": "208-265-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KEVIN",
        "middle_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-09-03",
        "last_updated": "2013-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John M Ukich
• John Wilson DDS, PLLC
• Alexi Jordan Johnson, DO
• Emily Johnson, OT
• Katherine Johnson, CPNP-PC
• Jennifer Jones, P.T.
• Toni Jones, LPCP
• Rene L. Jourdan, LCPC
• Journey Pediatric Therapy
• Jill Shelley Kahn, M.A.

• General Practice Dentistry in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2013; 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.