Blake Alan Johnson, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

30-024669 Issued in OH

Practice address

124 3Rd St
Marietta, OH 45750-3108

Phone

(740) 373-1826

Fax

(740) 373-1825

NPI assigned

Jul 7, 2015

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 23, 2015 through Oct 23, 2027

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• River City Dental Group, Inc

  • General Practice Dentistry
  • Marietta, OH
  • NPI 1851515043
  NPD (past)

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

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459296000000",
    "number": "1881077980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 3RD ST",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457503108",
            "telephone_number": "740-373-1826",
            "fax_number": "740-373-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 3RD ST",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457503108",
            "telephone_number": "740-373-1826",
            "fax_number": "740-373-1825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BLAKE",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-07",
        "last_updated": "2016-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-024669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John a Bays OD & Assoc
• John Nash DO LLC
• Arlena John
• Tonya Johns, COTA
• Alicia Johnson
• Dana L Johnson, CNP
• John Zachary Johnson
• Molly Johnson, APRN
• Scott E Johnson, M.D.
• Tawna Lynn Johnson, CRNA

• Dentist in Marietta, OH
• Providers in Marietta, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.