Provider Demographics
NPI:1780796821
Name:JOHNSTON, CHERYL LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LEE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:31506 RAILROAD CANYON RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9412
Mailing Address - Country:US
Mailing Address - Phone:951-244-3011
Mailing Address - Fax:951-244-0306
Practice Address - Street 1:31506 RAILROAD CANYON RD
Practice Address - Street 2:SUITE #3
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-9412
Practice Address - Country:US
Practice Address - Phone:951-244-3011
Practice Address - Fax:951-244-0306
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA390171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice