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Deactivated NPI 1891934493 Deactivated / Inactive NPI Male Practitioner

Dr. Kenneth Ray Johnson , DMD

Dentist • Corvallis, OR

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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. Kenneth Johnson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date February 05, 2009
NPI Deactivation Date February 17, 2020
Total Practice Duration ~11 Years of Practice (2009 – 2020)

Professional Overview & Biography Verified Profile Summary

Dr. Kenneth Johnson, DMD was a registered Dentist practicing in Corvallis, OR. Throughout an active medical career spanning 11 years, Dr. Johnson provided care at the practice location at 1112 NW CIRCLE BLVD until profile deactivation on 2020-02-17.

Practice Location & Contact Primary Location

Practice Address

1112 Nw Circle Blvd

Corvallis, OR 973301462

Telephone 5417571909
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Corvallis, OR

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 13.2 Yrs
Regional Practice Density
22 Specialists

Practicing in Corvallis, OR (1289 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 Primary Specialty

NUCC Taxonomy Code: 122300000X

State License OR 3870

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Practice Associates & Co-Workers

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

5 Associated Practitioners
Dr. Thien Chuong Richard Ly , MD

Psychiatry & Neurology - Psychiatry

NPI 1093123051

Doctor of Medicine (M.D.)

Derek Gale , LPC

Counselor - Mental Health

NPI 1205957230

Licensed Professional Counselor

NPI 1598747305

Licensed Clinical Social Worker

Dr. Tyler Fanning , MD

Psychiatry & Neurology - Psychiatry

NPI 1760987473

Doctor of Medicine (M.D.)

Bakula Patel , RDH

Dental Hygienist

NPI 1770871121

Registered Dental Hygienist

Career & Practice History Timeline

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

7 Historical Events
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NPI Profile Deactivated February 17, 2020

Record deactivated on February 17, 2020

NPI Profile Active February 05, 2009

NPI status registered as active in NPPES database

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Updated Practice Location February 05, 2009

Registered at 1112 NW CIRCLE BLVD, CORVALLIS, OR 973301462 (Tel: 5417571909)

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Updated Business Mailing Address February 05, 2009

Registered at 1112 NW CIRCLE BLVD, CORVALLIS, OR 973301462 (Tel: 5417571909)

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Provider Name / Credentials Updated February 05, 2009

Recorded as KENNETH JOHNSON, DMD

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 05, 2009

Dentist (License #3870 in OR)

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Initial NPI Registration & Enumeration February 05, 2009

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: 1891934493
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 05, 2009
Last Update: February 05, 2009
Deactivation Date: February 17, 2020

Mailing Address

1112 Nw Circle Blvd

Corvallis, OR 973301462

Phone: 5417571909

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.