Provider Demographics
NPI:1194815928
Name:JOHNSTON, KELLY (DMD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:4300 E SUNSET RD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2267
Mailing Address - Country:US
Mailing Address - Phone:702-968-0707
Mailing Address - Fax:702-968-0708
Practice Address - Street 1:4300 E SUNSET RD
Practice Address - Street 2:SUITE B2
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2267
Practice Address - Country:US
Practice Address - Phone:702-968-0707
Practice Address - Fax:702-968-0708
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice