NPIMap

Organization Active NPI

Collis Johnson Jr DDS PC

  • Dentist
  • Denver, CO
National Provider Identifier
1922212943
Registry record updated Sep 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
104176 Issued in CO
Legal business name
COLLIS JOHNSON JR DDS PC
Doing business as
Family Dentistry
Practice address
1756 Vine St
Denver, CO 80206
Phone
(303) 322-1177
Fax
(303) 322-1199
NPI assigned
May 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2008

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

Authorized official

Name
Dr. Collis Johnson, DDS
Title
Dentist Owner PC
Phone
(303) 322-1177

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 104176 CO Primary

Addresses

Primary practice location

1756 Vine St
Denver, CO 80206

Mailing address

1756 Vine St
Denver, CO 80206
Phone (303) 322-1177

Other identifiers 2

IdentifierTypeStateIssuer
1831291855OtherCONATIONAL PROVIDER TYPEI
02014769MedicaidCO

Other names 1

  • Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Family Dentistry4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220313600000",
    "number": "1922212943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1756 VINE ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "80206",
            "telephone_number": "303-322-1177",
            "fax_number": "303-322-1199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1756 VINE ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "80206",
            "telephone_number": "303-322-1177",
            "fax_number": "303-322-1199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIS JOHNSON JR DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2008-09-02",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "COLLIS",
        "authorized_official_title_or_position": "DENTIST OWNER PC",
        "authorized_official_telephone_number": "303-322-1177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "104176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL PROVIDER  TYPEI",
            "identifier": "1831291855",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02014769",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2008; 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.