Carl Kenneth Johnson, DDS

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

6475 Issued in WA

Practice address

601 S Carr Rd
#300
Renton, WA 98055-5840

Phone

(425) 277-1844

Fax

(425) 271-6766

NPI assigned

Oct 2, 2006

Last updated

Oct 7, 2016By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 22, 2022 through Dec 22, 2026

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pacific Northwest Oral and Maxillofacial Surgery

  • Oral and Maxillofacial Surgery Clinic/Center
  • Federal Way, WA
  • NPI 1689080467
  Authorized official Same address or phone
• Benjamin Johnson DDS, PLLC.

  dba Pacific Northwest Oral and Maxillofacial Surgeons

  • Oral and Maxillofacial Surgery (Dentist)
  • Burien, WA
  • NPI 1063253672
  NPD (past)
• Edwards, Johnson, Johnson & Johnson D.D.S., P.L.L.C.

  dba Pacific Northwest Oral & Maxillofacial Surgeons

  • Oral and Maxillofacial Surgery (Dentist)
  • Renton, WA
  • NPI 1255803904
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475798400000",
    "number": "1952494676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S. CARR RD",
            "address_2": "#300",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555840",
            "telephone_number": "425-277-1844",
            "fax_number": "425-271-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S CARR RD",
            "address_2": "#300",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555840",
            "telephone_number": "425-277-1844",
            "fax_number": "425-271-6766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CARL",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2016-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "WA",
            "license": "6475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Miles Johnson, DDS
• Anita Desiree Johnson, SLP
• Arthur Egene Johnson, CDP
• Benjamin Erskine Johnson, PSY.D.
• Benjamin Reed Johnson, D.M.D.
• Cheryl Johnson, PHARMACY TECHNICIAN
• Christopher Johnson
• Courtney Lois Johnson, PA-C
• Erica Leilani Johnson, APRN
• Jalene L Johnson, LMP

• Oral and Maxillofacial Pathology Dentistry in Renton, WA
• Providers in Renton, WA by specialty
• Oral and Maxillofacial Pathology Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.