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General NPI Number Information
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NPI Number | 1538532569
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Entity Type | Organization
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Legal Business Name | THOMAS C. JOHNSTON D.D.S., P.C.
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 5685 S 1475 E #4A
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4716
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Country | US
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Telephone | 801-475-4646
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Fax |
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Provider Business Mailing Address
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Address Line | 5685 S 1475 E #4A
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4716
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Country | US
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Telephone | 801-475-4646
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS C JOHNSTON
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Credential | D.D.S.
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Telephone | 801-475-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 142246
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License Number State | UT
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