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NPI Code Detail

MEDICARE: DR. JAMES CLARK JOHNSON JR. D.D.S.

MEDICARE: DR. JAMES CLARK JOHNSON JR. D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry7778NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1902WROTHERNCBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710055181
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES CLARK JOHNSON JR. D.D.S.
Provider Business Mailing Address
First Line : 3606 MEDICAL PARK CT
Second Line :
City : MOREHEAD CITY
State : NC
Zip : 28557-4347
Country : US
Telephone Number : 252-247-0500
Fax Number : 252-726-5964
Provider Business Practice Location Address
First Line : 3606 MEDICAL PARK CT
Second Line :
City : MOREHEAD CITY
State : NC
Zip : 28557-4347
Country : US
Telephone Number : 252-247-0500
Fax Number : 252-726-5964
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2006
Last Update Date : 04/26/2023

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