Provider Demographics
NPI:1952569220
Name:WILLIAM S JOHNSTON DDS PA
Entity type:Organization
Organization Name:WILLIAM S JOHNSTON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-455-0505
Mailing Address - Street 1:1545 LIVINGTON AVE SUITE 101
Mailing Address - Street 2:
Mailing Address - City:W ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118
Mailing Address - Country:US
Mailing Address - Phone:651-455-0505
Mailing Address - Fax:651-455-0625
Practice Address - Street 1:1545 LIVINGTON AVE SUITE 101
Practice Address - Street 2:
Practice Address - City:W ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118
Practice Address - Country:US
Practice Address - Phone:651-455-0505
Practice Address - Fax:651-455-0625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10556122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty