Provider Demographics
NPI:1083799571
Name:JOHNSTON, DAVID H (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
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 1:102 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5170
Mailing Address - Country:US
Mailing Address - Phone:308-532-3865
Mailing Address - Fax:
Practice Address - Street 1:102 S ELM ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5170
Practice Address - Country:US
Practice Address - Phone:308-532-3865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE4289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055690800Medicaid