Provider Demographics
NPI:1053475624
Name:HARKINS, HANCOCK AND JOHNSTON DENTISTRY
Entity Type:Organization
Organization Name:HARKINS, HANCOCK AND JOHNSTON DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-797-6453
Mailing Address - Street 1:11010 QUAKER AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8316
Mailing Address - Country:US
Mailing Address - Phone:806-797-6453
Mailing Address - Fax:806-791-2273
Practice Address - Street 1:11010 QUAKER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-8316
Practice Address - Country:US
Practice Address - Phone:806-797-6453
Practice Address - Fax:806-791-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty