Provider Demographics
NPI:1770700403
Name:JOHNSTON, DOUGLAS LESLIE (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LESLIE
Last Name:JOHNSTON
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 1:13111 E BRIARWOOD AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3930
Mailing Address - Country:US
Mailing Address - Phone:303-632-3638
Mailing Address - Fax:303-632-3690
Practice Address - Street 1:13111 E. BRIARWOOD AVE.
Practice Address - Street 2:SUITE 225
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-9902
Practice Address - Country:US
Practice Address - Phone:303-632-3638
Practice Address - Fax:303-632-3638
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist