Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1316975568 Individual Practitioner Male Practitioner

Dr. Jerry Lee Johnson , DDS

Dentist - General Practice • Worthington, MN

Professional Overview & Biography Verified Profile Summary

Dr. Jerry Johnson, DDS is a registered healthcare professional specializing in Dentist - General Practice in Worthington, MN. Practice services are available at 1316 MCMILLAN ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1316 Mcmillan St

Worthington, MN 561871646

Telephone 5073765525
Fax 5073763796
Associated Practice Facility / Clinic
🏢 Friendly Dental Facility NPI 1770672958

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Worthington, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 33.3 Yrs
Regional Practice Density
8 Specialists

Practicing in Worthington, MN (2262 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MN 10185

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Dentist - General Practice

NUCC Taxonomy Code: 1223G0001X

State License IA 7092

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
687623400 (MN)
Commercial Insurance / Payer ID Delta
10185 (MN)
Commercial Insurance / Payer ID Bcbs
176K2JO (IA)
Commercial Insurance / Payer ID United Concordia
820-685
Commercial Insurance / Payer ID Delta
0964114 (IA)
Commercial Insurance / Payer ID Bcbs
46482JO (MN)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners
Angela Johnson , RDH

Dental Hygienist

NPI 1487830360

Registered Dental Hygienist

Alyssa Nordell

Dental Hygienist

NPI 1578749743
Dr. Valerie Vadnais , DMD

Dentist - General Practice

NPI 1588786164

Doctor of Dental Medicine

NPI 1902414311
Dr. Kelly Phillips , DDS

Dentist - General Practice

NPI 1922167410

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 1316 MCMILLAN ST, WORTHINGTON, MN 561871646 (Tel: 5073765525)

📍
Updated Business Mailing Address July 08, 2007

Registered at 29847 260TH ST, WORTHINGTON, MN 561876365 (Tel: 5073769253)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as JERRY JOHNSON, D.D.S

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #10185 in MN)

🟢
Initial NPI Registration & Enumeration June 28, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1316975568
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 28, 2006
Last Update: July 08, 2007
Sole Proprietor: No

Mailing Address

29847 260th St

Worthington, MN 561876365

Phone: 5073769253

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.