Dr. Thomas Merle Johnson , DDS
Dentist - Periodontics • Bloomington, IL
Notice of NPI Deactivation & Inactive Practice Status
According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Thomas Johnson has officially deactivated this NPI record and ceased active healthcare practice.
Professional Overview & Biography Verified Profile Summary
Dr. Thomas Johnson, DDS was a registered Dentist - Periodontics practicing in Bloomington, IL. Throughout an active medical career spanning 14 years, Dr. Johnson provided care at the practice location at 2103 E WASHINGTON ST STE 4A until profile deactivation on 2021-01-13.
Practice Location & Contact Primary Location
2103 E Washington St Ste 4a
Bloomington, IL 617014365
Specialty Benchmarks & Practice Insights
Comparative analytics for Dentist - Periodontics in Bloomington, IL
Practicing in Bloomington, IL (229 Statewide)
In-Person Office Visits Only
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Medical Specialties & State Licenses
NUCC Taxonomy Code: 1223P0300X
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
Career & Practice History Timeline
Chronological log of verified NPI updates, location relocations, credentials, and registry changes
Record deactivated on January 13, 2021
NPI status registered as active in NPPES database
Registered at 2103 E WASHINGTON ST STE 4A, BLOOMINGTON, IL 617014365 (Tel: 3096621357)
Registered at 24 PENDLETON WAY, BLOOMINGTON, IL 617046273 (Tel: 3096625206)
Recorded as THOMAS JOHNSON, D.D.S.
Dentist
First registered as active Individual Practitioner in NPPES Database.
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NPI Administrative Meta
Mailing Address
24 Pendleton Way
Bloomington, IL 617046273
Phone: 3096625206
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