Craig Alan Johnson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D13228 Issued in MN

Practice address

1416 Central Ave NE
East Grand Forks, MN 56721-1605

Phone

(218) 773-3004

Fax

(218) 773-3006

NPI assigned

Jul 17, 2013

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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1374019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374019200000",
    "number": "1902248057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 CENTRAL AVE NE",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "567211605",
            "telephone_number": "218-773-3004",
            "fax_number": "218-773-3006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1416 CENTRAL AVE NE",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "567211605",
            "telephone_number": "218-773-3004",
            "fax_number": "218-773-3006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CRAIG",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-17",
        "last_updated": "2013-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Moustapha Awaleh Ibrahim
• In-Near Home Health LLC
• Irvin M. Galstad DDS LTD
• Lisa Jo Jamsa Tollefson, MD
• Lisa Jean Jeffrey Brown, OTR/L
• Karen Johnsonatkinson, RN
• Brady Junes, MD
• Laurie T Jung, PT
• Autumn Kallock
• Sean Christian Karpowich, PHARMD

• General Practice Dentistry in East Grand Forks, MN
• Providers in East Grand Forks, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.