Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. DERRICK V JOHNSON
Deactivated Sole ProprietorDR. DERRICK V JOHNSON is a Dentist healthcare provider located in MOUNTAIN HOME, Arkansas. NPI 1407963762 is deactivated in the NPPES registry. Verify at CMS.
Dentist · MOUNTAIN HOME, AR
This NPI has been deactivated.
The record was deactivated on July 11, 2012.
Deactivated NPIs are no longer valid for billing or credentialing. The provider may have retired, changed practice status, or had their NPI administratively deactivated.
Verify current licensure status with the NPPES NPI Registry or the relevant state medical board before relying on this record.
Registration Details
- NPI Number
- 1407963762
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Aug 24, 2006 (5.879781420765 yrs)
- Last Updated
- Jun 9, 2015
- Deactivated
- Jul 11, 2012
- Licenses
-
4583 (AZ)AR3739 (AR)
- Sole Proprietor
- Yes
Practice Information
- Address
-
114 DYER STREETMOUNTAIN HOME, AR, 72653Browse AR providers · Browse ZIP 72653
- Phone
- 8705800950
- Fax
- 8705800951
- Primary Specialty
-
Dentist
122300000X
- Additional Specialty
- Dentist
Other Dentist Providers in MOUNTAIN HOME, AR
| Name | Credential | NPI |
|---|---|---|
| DR. RANDY S. SIMPSON | D.D.S. | 1114946811 |
| MR. BERNARD W PETKOVICH | DDS PA | 1336253582 |
| DR. STEPHEN DOUGLAS VESTER | DDS PA | 1073601969 |
| DR. IRVIN MATTHEW DEATLEY | D.D.S. | 1164541348 |
| DR. CHRISTINA CATHERINE DEATLEY | D.D.S. | 1316067473 |
| BRADLEY WAYNE COLEMAN | D.D.S. | 1124287693 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.