Provider Demographics
NPI:1225035603
Name:JOHNSTONE, DALE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:R
Last Name:JOHNSTONE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CALLE MALAGUENA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2357
Mailing Address - Country:US
Mailing Address - Phone:714-904-6808
Mailing Address - Fax:
Practice Address - Street 1:510 CALLE MALAGUENA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-2357
Practice Address - Country:US
Practice Address - Phone:714-904-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225071223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics