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General NPI Number Information
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NPI Number | 1548620107
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Entity Type | Individual
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Provider Name | TARA MARIA JOHNSTON DDS
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Gender | Female
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Dates
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Enumeration Date | 02/25/2016
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 210 SAN MATEO RD STE 104
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City | HALF MOON BAY
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State | CA
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Zip | 94019-7172
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Country | US
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Telephone | 650-726-2144
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Fax |
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Provider Business Mailing Address
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Address Line | 430 N EL CAMINO REAL
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City | SAN MATEO
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State | CA
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Zip | 94401-3710
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Country | US
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Telephone | 650-727-3480
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 100418
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License Number State | CA
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