Provider Demographics
NPI:1023557493
Name:JOHNSTON, ELENA AMELIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:AMELIA
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2382 PHLOX CT
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1198
Mailing Address - Country:US
Mailing Address - Phone:215-769-7696
Mailing Address - Fax:
Practice Address - Street 1:2382 PHLOX CT
Practice Address - Street 2:
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929-1198
Practice Address - Country:US
Practice Address - Phone:215-760-7696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-18
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program