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NPI Code Detail

MEDICARE: DR. ANTHONY E JOHNSTON D.D.S.

MEDICARE: DR. ANTHONY E JOHNSTON D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1184632325
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANTHONY E JOHNSTON D.D.S.
Provider Business Mailing Address
First Line : 9037 RIVER VIEW TRL
Second Line :
City : ROSCOE
State : IL
Zip : 61073-6608
Country : US
Telephone Number : 815-623-1510
Fax Number :
Provider Business Practice Location Address
First Line : 1301 N ALPINE RD
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-2262
Country : US
Telephone Number : 815-397-4280
Fax Number : 815-484-2436
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 07/08/2007

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