Provider Demographics
NPI:1710055181
Name:JOHNSON, JAMES CLARK JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLARK
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 MEDICAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4347
Mailing Address - Country:US
Mailing Address - Phone:252-247-0500
Mailing Address - Fax:252-726-5964
Practice Address - Street 1:3606 MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4347
Practice Address - Country:US
Practice Address - Phone:252-247-0500
Practice Address - Fax:252-726-5964
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC902WROtherBCBS
NC89902WR-89016ERMedicaid