Provider Demographics
NPI:1144390238
Name:JOHNSTON, MARGARET WILSON (DDS)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:WILSON
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 NE CAMPUS WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5611
Mailing Address - Country:US
Mailing Address - Phone:509-952-2125
Mailing Address - Fax:
Practice Address - Street 1:133 DEXTER AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5103
Practice Address - Country:US
Practice Address - Phone:206-324-5453
Practice Address - Fax:206-323-2872
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000063021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5120068Medicaid