Provider Demographics
NPI:1629086566
Name:JOHNSTON, LILLIAN DIANE (DDS)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:DIANE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11346 MOUNTAIN VIEW AVE
Mailing Address - Street 2:STE D
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:909-796-0099
Mailing Address - Fax:909-796-9036
Practice Address - Street 1:11346 MOUNTAIN VIEW AVE
Practice Address - Street 2:STE D
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-796-0099
Practice Address - Fax:909-796-9036
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice