Jeremiah O. Johnson, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

60337452 Issued in WA

Practice address

304 N Chelan Ave
Wenatchee, WA 98801-2107

Phone

(509) 663-0068

Fax

(509) 663-0060

NPI assigned

Aug 31, 2006

Last updated

Feb 26, 2020By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wenatchee Valley Oral and Facial Surgery

  • Oral and Maxillofacial Surgery Clinic/Center
  • Wenatchee, WA
  • NPI 1689090110
  NPD Authorized official
• Starkweather Orthopedic & Sports Medicine Clinic

  • Specialist
  • Wenatchee, WA
  • NPI 1568638575
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582675200000",
    "number": "1922119189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 N. EMERSON AVE",
            "address_2": "SUITE #101",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "98801",
            "telephone_number": "509-663-0068",
            "fax_number": "509-663-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 N CHELAN AVE",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "988012107",
            "telephone_number": "509-663-0068",
            "fax_number": "509-663-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JEREMIAH",
        "middle_name": "O.",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "60337452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2036913",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carole Ann Johnson, MA CCCA
• Carolyn R Johnson, ARNP
• Cristina Maria Johnson, L.M.P.
• Elisa Ann Johnson
• James Brockbank Johnson, MD
• Jill M Johnson, ND
• Joseph Lowell Johnson, M.D.
• Lauren D Johnson, PT
• Lucilla Debra Johnson
• Margaret M Johnson, SUDPT

• Oral and Maxillofacial Surgery (Dentist) in Wenatchee, WA
• Providers in Wenatchee, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2020; 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.