NPIMap

Organization Active NPI

Danville Pediatric Dentistry, PSC

  • General Practice Dentistry
  • Danville, KY
National Provider Identifier
1760772230
Registry record updated Oct 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7737 Issued in KY
Legal business name
DANVILLE PEDIATRIC DENTISTRY, PSC
Practice address
1080 Ben Ali Dr
Suite a
Danville, KY 40422-8937
Phone
(859) 236-6900
Fax
(859) 236-6997
NPI assigned
Apr 18, 2011
Last updated
Oct 25, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2016

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

Authorized official

Name
Jeffrey T Johnson, D.M.D.M.PH.NPI 1881658946
Title
Owner
Phone
(859) 236-6900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 7737 KY Primary
Pediatric Dentistry 1223P0221X 7737 KY

Addresses

Primary practice location

1080 Ben Ali Dr
Suite a
Danville, KY 40422-8937

Mailing address

1080 Ben Ali Dr
Suite a
Danville, KY 40422-8937
Phone (859) 236-6900

Other identifiers 2

IdentifierTypeStateIssuer
1223P0221XMedicaidKY
1223G0001XOtherKYEPSDT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1303084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477353600000",
    "number": "1760772230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 BEN ALI DR",
            "address_2": "SUITE A",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404228937",
            "telephone_number": "859-236-6900",
            "fax_number": "859-236-6997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 BEN ALI DR",
            "address_2": "SUITE A",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404228937",
            "telephone_number": "859-236-6900",
            "fax_number": "859-236-6997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANVILLE PEDIATRIC DENTISTRY, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-18",
        "last_updated": "2016-10-25",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "859-236-6900",
        "authorized_official_credential": "D.M.D.M.PH."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "7737",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "7737",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1223P0221X",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EPSDT",
            "identifier": "1223G0001X",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; 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.