MEDICARE: JOHNSON ORTHODONTICS

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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

Other Identifiers

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

General Provider Information

NPI Number	:	1477188407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON ORTHODONTICS

Provider Business Mailing Address
First Line	:	5850 TUTT CENTER PT STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-3520
Country	:	US
Telephone Number	:	719-596-3081
Fax Number	:

Provider Business Practice Location Address
First Line	:	6620 CAMDEN BLVD
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-2505
Country	:	US
Telephone Number	:	719-631-6649
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WARREN JOHNSON
Credential	:	DDS
Telephone Number	:	719-432-9807

Provider Enumeration Date	:	03/10/2020
Last Update Date	:	08/05/2022

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Directions to “JOHNSON ORTHODONTICS ” Practice Location

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