Provider Demographics
NPI:1043421365
Name:JOHNSTON, CRAIG PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:PETER
Last Name:JOHNSTON
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 1:22619 SE 64TH PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5342
Mailing Address - Country:US
Mailing Address - Phone:425-391-1674
Mailing Address - Fax:
Practice Address - Street 1:22619 SE 64TH PL
Practice Address - Street 2:SUITE 110
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5342
Practice Address - Country:US
Practice Address - Phone:425-391-1674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA59991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery