Active NPI
Mark W Johnston, DMD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Marietta, GA
National Provider Identifier
1881603041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 10404
- Practice address
- 1070 Woodlawn Dr NE
Suite 200
Marietta, GA 30068-4264 - Phone
- (770) 973-1070
- Fax
- (770) 973-4466
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 10404 | GA | Primary |
Addresses
Primary practice location
1070 Woodlawn Dr NE
Suite 200
Marietta, GA 30068-4264
Mailing address
1070 Woodlawn Dr NE
Suite 200
Marietta, GA 30068-4264
Phone (770) 973-1070
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 |
|---|---|---|---|
| 10404 | GA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881603041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1070 WOODLAWN DR NE",
"address_2": "SUITE 200",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300684264",
"telephone_number": "770-973-1070",
"fax_number": "770-973-4466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1070 WOODLAWN DR NE",
"address_2": "SUITE 200",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300684264",
"telephone_number": "770-973-1070",
"fax_number": "770-973-4466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTON",
"first_name": "MARK",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "GA",
"license": "10404",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.