Provider Demographics
NPI:1164810941
Name:JOHNSTON DENTAL CARE LLC
Entity Type:Organization
Organization Name:JOHNSTON DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-479-6623
Mailing Address - Street 1:1215 NE 7TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1450
Mailing Address - Country:US
Mailing Address - Phone:541-479-6623
Mailing Address - Fax:541-479-6776
Practice Address - Street 1:1215 NE 7TH ST STE A
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1450
Practice Address - Country:US
Practice Address - Phone:541-479-6623
Practice Address - Fax:541-479-6776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty