Healthcare Provider Details

I. General information

NPI: 1194265686
Provider Name (Legal Business Name): GEOFFREY JOHNSTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 TRUEMPER ST
JBSA LACKLAND TX
78236-5511
US

IV. Provider business mailing address

1615 TRUEMPER ST
JBSA LACKLAND TX
78236-5511
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-0123
  • Fax:
Mailing address:
  • Phone: 210-292-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number30.024226
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: