Sara Lue Johnson

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D012239 Issued in AZ

Practice address

710 N Beaver St BLDG 2
Flagstaff, AZ 86001-3145

Phone

(206) 543-6365

NPI assigned

Feb 21, 2024

Sex

Female

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1708473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1790540482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N BEAVER ST BLDG 2",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013145",
            "telephone_number": "206-543-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 N BEAVER ST BLDG 2",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013145",
            "telephone_number": "206-543-6365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SARA",
        "middle_name": "LUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-21",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D012239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Johnson, ACNPC-AG
• Lori Sue Johnson, COTA/L
• Lynn Cooper Johnson, FNP
• Mackenzie Renae Johnson
• Ronald T Johnson Jr., ED. D.
• Summer Faith Johnson, FNP-C
• Tarryn Eve Johnson
• Thomas J Johnson, O.D.
• Brooke Joiner
• Alissa Anne Jones, PT

• General Practice Dentistry in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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.