Provider Demographics
NPI:1881603041
Name:JOHNSTON, MARK W (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:1070 WOODLAWN DR NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4264
Mailing Address - Country:US
Mailing Address - Phone:770-973-1070
Mailing Address - Fax:770-973-4466
Practice Address - Street 1:1070 WOODLAWN DR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4264
Practice Address - Country:US
Practice Address - Phone:770-973-1070
Practice Address - Fax:770-973-4466
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA104041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics