NPIMap

Organization Active NPI

Fusion Dental at Clear Creek PLLC

  • Dentist
  • Killeen, TX
National Provider Identifier
1851702872
Registry record updated Sep 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
25786 Issued in TX
Legal business name
FUSION DENTAL AT CLEAR CREEK PLLC
Practice address
4102 S Clear Creek Rd Ste 102
Killeen, TX 76549-5954
Phone
(254) 213-5773
NPI assigned
May 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2014

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

Authorized official

Name
Johnny W Johnson
Title
Owner/Dentist
Phone
(254) 213-5773

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 25786 TX Primary

Addresses

Primary practice location

4102 S Clear Creek Rd Ste 102
Killeen, TX 76549-5954

Mailing address

4102 S Clear Creek Rd Ste 102
Killeen, TX 76549-5954
Phone (254) 213-5773

National Provider Directory

National Provider Directory

Locations

4102 Clear Creek Rd
Ste 102
Killeen, TX 76549
Phone (254) 213-5773

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411430400000",
    "number": "1851702872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4102 S CLEAR CREEK RD STE 102",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765495954",
            "telephone_number": "254-213-5773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4102 S CLEAR CREEK RD STE 102",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765495954",
            "telephone_number": "254-213-5773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUSION DENTAL AT CLEAR CREEK PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-13",
        "last_updated": "2014-09-23",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JOHNNY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "254-213-5773"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "25786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Killeen, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; 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.