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General NPI Number Information
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NPI Number | 1225714538
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Entity Type | Individual
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Provider Name | YOLEIDY TATIANA JOHNSTONE DMD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2023
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 1529 ROUTE 206
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City | TABERNACLE
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State | NJ
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Zip | 08088-8801
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Country | US
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Telephone | 609-388-1101
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Fax |
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Provider Business Mailing Address
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Address Line | 10 BELOIT AVE
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City | AUDUBON
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State | NJ
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Zip | 08106-2302
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02976200
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License Number State | NJ
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