Provider Demographics
NPI:1104041961
Name:JOHNSTON, FREDERICK L (DDD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:L
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 HONEY SUCKLE CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8219
Mailing Address - Country:US
Mailing Address - Phone:925-833-0535
Mailing Address - Fax:925-833-8019
Practice Address - Street 1:4101 DUBLIN BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-4592
Practice Address - Country:US
Practice Address - Phone:925-833-0535
Practice Address - Fax:925-833-8019
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics