Provider Demographics
NPI:1568663029
Name:BRIAN E JOHNSTON DMD PA
Entity Type:Organization
Organization Name:BRIAN E JOHNSTON DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF COMPANY
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-825-1185
Mailing Address - Street 1:103 CHRISTIAN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2762
Mailing Address - Country:US
Mailing Address - Phone:601-825-1172
Mailing Address - Fax:601-825-1185
Practice Address - Street 1:103 CHRISTIAN DR
Practice Address - Street 2:SUITE B
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2762
Practice Address - Country:US
Practice Address - Phone:601-825-1172
Practice Address - Fax:601-825-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty