Provider Demographics
NPI:1164519336
Name:JOHNSTON, CUE BERNARD (DMD)
Entity Type:Individual
Prefix:MR
First Name:CUE
Middle Name:BERNARD
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:1801 WEST MAIN STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301
Mailing Address - Country:US
Mailing Address - Phone:334-792-3313
Mailing Address - Fax:334-792-0293
Practice Address - Street 1:1801 WEST MAIN STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301
Practice Address - Country:US
Practice Address - Phone:334-792-3313
Practice Address - Fax:334-792-0293
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL27681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
93712OtherBLUE CROSS BLUE SHIELD
404364OtherUNITED CONCORDIA