Active NPI
David Bruce Johnson, DDS
- General Practice Dentistry
- Salem, MO
National Provider Identifier
1982779112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 012259
- Practice address
- 102 N Main St
Salem, MO 65560 - Phone
- (573) 729-5424
- Fax
- (573) 729-0209
- NPI assigned
- Nov 22, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 012259 | MO | Primary |
Addresses
Primary practice location
102 N Main St
Salem, MO 65560
Mailing address
PO Box 525
Salem, MO 65560
Phone (573) 729-5424
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150202000070 | MO | Order and Referring Only - General Practice | 3870817463 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012259 | MO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982779112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 525",
"city": "SALEM",
"state": "MO",
"postal_code": "65560",
"telephone_number": "573-729-5424",
"fax_number": "573-729-0209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 N MAIN ST",
"city": "SALEM",
"state": "MO",
"postal_code": "65560",
"telephone_number": "573-729-5424",
"fax_number": "573-729-0209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "DAVID",
"middle_name": "BRUCE",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "012259",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, MO
- Amber A. Hogan, APRN, FNP-C
- Holistic Expectations Birth Services LLC
- Kimberely L Ingram, LPC
- Andrea Elizabeth Jadwin, PHARM D
- Kaylie Jay
- Bradley D. Jones, D.O.
- Kimberly Ann Kemnitzer, FNP-C
- Key Rehabilitation,Inc. (GeroPsych, a division of Key Rehabilitation, Inc.)
- Erum Khan, M.D.
- Kailie Kinder, SLP-A
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.