Jordan Tyler Johnson, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

13039 Issued in NC

Practice address

59 Haywood Park Dr
Clyde, NC 28721-4404

Phone

(828) 627-1999

Fax

(828) 627-1998

NPI assigned

Jun 8, 2020

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Tadrissi DDS, PLLC

  • Endodontics
  • Franklin, NC
  • NPI 1225462716
  NPD (past) Authorized official

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

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1932723715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 HAYWOOD PARK DR",
            "city": "CLYDE",
            "state": "NC",
            "postal_code": "287214404",
            "telephone_number": "828-627-1999",
            "fax_number": "828-627-1998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 HAYWOOD PARK DR",
            "city": "CLYDE",
            "state": "NC",
            "postal_code": "287214404",
            "telephone_number": "828-627-1999",
            "fax_number": "828-627-1998"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1216 6th Ave W Unit B",
            "address_purpose": "LOCATION",
            "city": "Hendersonville",
            "state": "NC",
            "postal_code": "287393301",
            "country_code": "US",
            "telephone_number": "828-693-7600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JORDAN",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-08",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NC",
            "license": "13039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vicki W. James, RN
• Richard Allen Jenkins, PTA
• Sylvia Pecyna Jernigan, DDS
• John M. Highsmith, DDS, PA
• Allison Evans Johnson, M.D.
• Patrick Johnson, RN-BC
• Kaya Kaminski
• Kathryn L. Conard, DDS, Ms, PLLC
• Shawn Robert Kennedy, DDS
• Kathryn Ann Keogh, PHD, MSN, RN

• Endodontics in Clyde, NC
• Providers in Clyde, NC by specialty
• Endodontics in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; 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.