Active NPI
Michael B Johnson, DDS
- Dentist
- Tishomingo, OK
National Provider Identifier
1841493236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11189
- Practice address
- 815 E 6TH St
Tishomingo, OK 73460-2847 - Phone
- (580) 421-4570
- Fax
- (580) 421-6283
- NPI assigned
- Jun 6, 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 | 11189 | TX | Primary |
Addresses
Primary practice location
815 E 6TH St
Tishomingo, OK 73460-2847
Mailing address
1001 N Country Club Rd
Ada, OK 74820-2847
Phone (580) 421-4570
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11189 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11189 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chickasaw Nation Division of Health | 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.
-
- Home Health Agency
- Ada, OK
- NPI 1811739071
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211932800000",
"number": "1841493236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 N COUNTRY CLUB RD",
"city": "ADA",
"state": "OK",
"postal_code": "748202847",
"telephone_number": "580-421-4570",
"fax_number": "580-421-6283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "815 E 6TH ST",
"city": "TISHOMINGO",
"state": "OK",
"postal_code": "734602847",
"telephone_number": "580-421-4570",
"fax_number": "580-421-6283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MICHAEL",
"middle_name": "B",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-06",
"last_updated": "2008-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "11189",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11189",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tishomingo, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.