Healthcare Provider Details

I. General information

NPI: 1104041961
Provider Name (Legal Business Name): FREDERICK L. JOHNSTON D.D.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 DUBLIN BLVD SUITE E
DUBLIN CA
94568-4592
US

IV. Provider business mailing address

1518 HONEY SUCKLE CT
PLEASANTON CA
94588-8219
US

V. Phone/Fax

Practice location:
  • Phone: 925-833-0535
  • Fax: 925-833-8019
Mailing address:
  • Phone: 925-833-0535
  • Fax: 925-833-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number24989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: