Healthcare Provider Details

I. General information

NPI: 1346793197
Provider Name (Legal Business Name): NICOLE MARIE JOHNSTON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE MARIE VOELLER DDS

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CALIFORNIA AVE SW
SEATTLE WA
98116-4102
US

IV. Provider business mailing address

4150 CALIFORNIA AVE SW
SEATTLE WA
98116-4102
US

V. Phone/Fax

Practice location:
  • Phone: 62-935-1855
  • Fax:
Mailing address:
  • Phone: 62-935-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE6061562
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60671562
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: