Organization Active NPI

D. Todd Johnson DDS, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Broken Arrow, OK
National Provider Identifier
1912221052
Registry record updated Dec 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
5019 Issued in OK
Legal business name
D. TODD JOHNSON DDS, PC
Practice address
4716 W Urbana St
Broken Arrow, OK 74012-5997
Phone
(918) 449-5800
Fax
(918) 455-8958
NPI assigned
Mar 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2010

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

Authorized official

Name
Julia E Sams
Title
Contract Coordinator
Phone
(918) 449-5800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 5019 OK Primary

Addresses

Primary practice location

4716 W Urbana St
Broken Arrow, OK 74012-5997

Mailing address

4716 W Urbana St
Broken Arrow, OK 74012-5997
Phone (918) 449-5800

Other identifiers 1

IdentifierTypeStateIssuer
100091300AMedicaidOK

National Provider Directory

National Provider Directory

Locations

12455 E 100th St N
Ste 240
Owasso, OK 74055
Phone (918) 274-0944

6132 E 61st St
Tulsa, OK 74136
Phone (918) 494-8634

NPI Registry JSON

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

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292803200000",
    "number": "1912221052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4716 W URBANA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740125997",
            "telephone_number": "918-449-5800",
            "fax_number": "918-455-8958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4716 W URBANA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740125997",
            "telephone_number": "918-449-5800",
            "fax_number": "918-455-8958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D. TODD JOHNSON DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-18",
        "last_updated": "2010-12-20",
        "status": "A",
        "authorized_official_last_name": "SAMS",
        "authorized_official_first_name": "JULIA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CONTRACT COORDINATOR",
        "authorized_official_telephone_number": "918-449-5800"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OK",
            "license": "5019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100091300A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; 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.