Healthcare Provider Details

I. General information

NPI: 1568470557
Provider Name (Legal Business Name): PAUL CHRISTOPHER JOHNSTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 HIGHWAY 55 SUITE 104
HASTINGS MN
55033-3734
US

IV. Provider business mailing address

925 HIGHWAY 55 SUITE 104
HASTINGS MN
55033-3734
US

V. Phone/Fax

Practice location:
  • Phone: 651-437-5340
  • Fax: 651-437-3780
Mailing address:
  • Phone: 651-437-5340
  • Fax: 651-437-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11870
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: