Jeremy Robert Johnson, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

202438 Issued in CO

Practice address

1006 A St
Greeley, CO 80631-2021

Phone

(970) 352-0048

Fax

(970) 352-1120

NPI assigned

Jun 25, 2008

Last updated

Aug 10, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sunrise Community Health

  dba Sunrise Family Dental

  • Federally Qualified Health Center (FQHC)
  • Greeley, CO
  • NPI 1699073395
  NPD (past)

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439164800000",
    "number": "1801058599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2930 11TH AVE",
            "city": "EVANS",
            "state": "CO",
            "postal_code": "806201011",
            "telephone_number": "970-350-4606",
            "fax_number": "970-350-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 A ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806312021",
            "telephone_number": "970-352-0048",
            "fax_number": "970-352-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JEREMY",
        "middle_name": "ROBERT",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-25",
        "last_updated": "2015-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "202438",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SD",
            "license": "DO816",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99074559",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chloe Johnson
• Eileen Kay Johnson
• Grace Johnson
• Herbert Elton Johnson, PA-C
• Jennifer Johnson, RBT
• Jillian D Johnson
• Julia Johnson
• Keilah Johnson
• Kelly Beth Johnson, NP
• Lauren Johnson

• Dentist in Greeley, CO
• Providers in Greeley, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2015; 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.