David Lynn Johnson – General Practice Dentistry

Key facts

NPI: 1821385097
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 7967464-9921 (UT)
Practice address: 3564 S 7200 W Ste B
Magna, UT 84044-3507
Phone: (801) 250-1717
Fax: (801) 250-6098
NPI assigned: Jul 7, 2011
Sex: Male
Sole proprietor: Yes

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.

Magna Dental Clinic General Practice Dentistry · Magna, UT · NPI 1790077915

NPD (past) GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment: Enrolled in UT
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20150717001421	UT	Order and Referring Only - Dentist Practitioner - Dentist	1658684709

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Magna Dental Clinic	General Practice	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry	1223G0001X	7967464-9921	UT	Yes

Addresses

Primary practice location

3564 S 7200 W Ste B
Magna, UT 84044-3507

Mailing address

3564 S 7200 W Ste B
Magna, UT 84044-3507
Phone (801) 250-1717

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 7, 2011.

{
    "created_epoch": "1309996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309996800000",
    "number": "1821385097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3564 S 7200 W STE B",
            "city": "MAGNA",
            "state": "UT",
            "postal_code": "840443507",
            "telephone_number": "801-250-1717",
            "fax_number": "801-250-6098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3564 S 7200 W STE B",
            "city": "MAGNA",
            "state": "UT",
            "postal_code": "840443507",
            "telephone_number": "801-250-1717",
            "fax_number": "801-250-6098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DAVID",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-07",
        "last_updated": "2011-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "7967464-9921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Magna, UT

All providers in Magna, UT · General Practice Dentistry in Utah

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2011. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.