Travis Allan Johnson, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D13205 Issued in MN

Practice address

9950 Valley Creek Rd Ste 100
Woodbury, MN 55125-5803

Phone

(651) 578-7000

Fax

(651) 578-0157

NPI assigned

May 24, 2013

Last updated

May 19, 2020By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral SurgeryAlso: Maxillofacial Surgery

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

True North Oral Surgery and Implants PLLCGroup PAC ID 7214212810, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• True North Oral Surgery and Implants PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Woodbury, MN
  • NPI 1285179945
  Medicare reassignment Care Compare group NPD
• Maplewood Oral and Maxillofacial Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Woodbury, MN
  • NPI 1003993304
  NPD (past)
• St Paul Oral Surgery and Dental Implants LLC

  dba St. Paul Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Paul, MN
  • NPI 1043870645
  NPD (past)
• St. Paul Oral Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • South St Paul, MN
  • NPI 1548218910
  NPD (past)

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

{
    "created_epoch": "1369353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589846400000",
    "number": "1841637295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9950 VALLEY CREEK RD STE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255803",
            "telephone_number": "651-578-7000",
            "fax_number": "651-578-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9950 VALLEY CREEK RD STE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255803",
            "telephone_number": "651-578-7000",
            "fax_number": "651-578-0157"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 Main St Ste 203",
            "address_purpose": "LOCATION",
            "city": "Mendota Heights",
            "state": "MN",
            "postal_code": "551183767",
            "country_code": "US",
            "telephone_number": "651-451-1873",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1420 Lake St S Ste 200",
            "address_purpose": "LOCATION",
            "city": "Forest Lake",
            "state": "MN",
            "postal_code": "550252713",
            "country_code": "US",
            "telephone_number": "651-578-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1560 Beam Ave Ste E",
            "address_purpose": "LOCATION",
            "city": "Maplewood",
            "state": "MN",
            "postal_code": "551091171",
            "country_code": "US",
            "telephone_number": "651-578-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TRAVIS",
        "middle_name": "ALLAN",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-24",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D13205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Valerie Johnson, PA-C
• Reed A Johnson, MD
• Ryan Daniel Johnson, OD
• Theresa Marie Johnson
• Tina Marie Johnson, M.D.
• Tyree Deshawn Johnson
• Victoria L Johnson, LPCC
• Cheyanne Lila Johonson
• Rose Joiner, LMFT
• Lori Jokinen, DC

• Oral and Maxillofacial Surgery (Dentist) in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.