Provider Demographics
NPI:1467448092
Name:JOHNSON, ROBERT KIRK (DSS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KIRK
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 AVIEMORE DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9797
Mailing Address - Country:US
Mailing Address - Phone:910-295-8088
Mailing Address - Fax:910-295-8855
Practice Address - Street 1:93 AVIEMORE DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9797
Practice Address - Country:US
Practice Address - Phone:910-295-8088
Practice Address - Fax:910-295-8855
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9044204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD006L223AMedicare ID - Type UnspecifiedMEDICARE PROV #
MDT59731Medicare UPIN