Provider Demographics
NPI:1043300411
Name:JOHNSTUN, RYAN C (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:C
Last Name:JOHNSTUN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:1150 SEEMAN ST
Mailing Address - City:DARRINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98241-0516
Mailing Address - Country:US
Mailing Address - Phone:360-436-1008
Mailing Address - Fax:360-436-1147
Practice Address - Street 1:1150 SEEMAN ST
Practice Address - Street 2:
Practice Address - City:DARRINGTON
Practice Address - State:WA
Practice Address - Zip Code:98241-0516
Practice Address - Country:US
Practice Address - Phone:360-436-1008
Practice Address - Fax:360-436-1147
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice