1639405269 NPI number — JAMES CLARK JOHNSON, JR., DDS, PA

Table of content: (NPI 1639405269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639405269 NPI number — JAMES CLARK JOHNSON, JR., DDS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES CLARK JOHNSON, JR., DDS, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JOHNSON FAMILY DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639405269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3606 MEDICAL PARK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOREHEAD CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28557-4347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-247-0500
Provider Business Mailing Address Fax Number:
252-726-5964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3606 MEDICAL PARK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOREHEAD CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557-4347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-247-0500
Provider Business Practice Location Address Fax Number:
252-726-5964
Provider Enumeration Date:
11/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
CLARK
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
252-247-0500

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  7778 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)