Provider Demographics
NPI:1740760651
Name:GEOFF JOHNSTON DDS PLLC
Entity Type:Organization
Organization Name:GEOFF JOHNSTON DDS PLLC
Other - Org Name:PAVLOVICH DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-528-7612
Mailing Address - Street 1:4150 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4102
Mailing Address - Country:US
Mailing Address - Phone:206-935-1855
Mailing Address - Fax:206-937-3996
Practice Address - Street 1:4150 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4102
Practice Address - Country:US
Practice Address - Phone:206-935-1855
Practice Address - Fax:206-937-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60671571261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental