Active NPI
Harold Cortez Johnson, DDS
- Dentist
- Warren, MI
National Provider Identifier
1790980167
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 013040
- Practice address
- 21761 Ryan Rd
Warren, MI 48091 - Phone
- (586) 758-3620
- Fax
- (586) 758-8279
- NPI assigned
- Jun 18, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 013040 | MI | Primary |
Addresses
Primary practice location
21761 Ryan Rd
Warren, MI 48091
Mailing address
PO Box 759
Troy, MI 48099-0759
Phone (586) 758-3620
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160113002972 | MI | Order and Referring Only - Dentist | 7618279282 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013040 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sunshine Dental Center PC | Dentist | 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 and National Provider Directory roles.
-
- Dentist
- Warren, MI
- NPI 1326171166
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790980167",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 759",
"city": "TROY",
"state": "MI",
"postal_code": "480990759",
"telephone_number": "586-758-3620",
"fax_number": "586-758-8279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21761 RYAN RD",
"city": "WARREN",
"state": "MI",
"postal_code": "48091",
"telephone_number": "586-758-3620",
"fax_number": "586-758-8279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "HAROLD",
"middle_name": "CORTEZ",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "013040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warren, MI
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.