Provider Demographics
NPI:1073681292
Name:JOHNSTON, CARROLL ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARROLL
Middle Name:ARTHUR
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 1:13435 MIDLANDS FARM LN
Mailing Address - Street 2:
Mailing Address - City:LOVETTSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20180
Mailing Address - Country:US
Mailing Address - Phone:540-882-4168
Mailing Address - Fax:540-882-4768
Practice Address - Street 1:150 ELDEN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170
Practice Address - Country:US
Practice Address - Phone:703-707-2070
Practice Address - Fax:703-707-0450
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411364122300000X
MD5964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist