NPI: 1770250292 · FAIRBANKS, AK 99701 · Pediatric Dentist · NPI assigned 08/24/2021
| Authorized Official | JOHNSON, GREGORY (MEMBER) |
| NPI Enumeration Date | 08/24/2021 |
Other providers sharing the same authorized official: JOHNSON, GREGORY
| Provider | City | State | Total Paid |
|---|---|---|---|
| TOLEDO EMERGENCY SERVICES | TOLEDO | IA | $86K |
| MINNIE STREET SURGERY CENTER, LLC | FAIRBANKS | AK | $45K |
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 27 | $2K |
| 2024 | 12 | $781.80 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0140 | Limited oral evaluation - problem focused | 39 | 37 | $2K |