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General NPI Number Information
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NPI Number | 1841497179
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Entity Type | Individual
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Provider Name | KATIE EILEEN JOHNSTON D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 3968 PINE GROVE AVE
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City | FORT GRATIOT
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State | MI
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Zip | 48059-4218
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Country | US
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Telephone | 810-984-2208
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Fax |
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Provider Business Mailing Address
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Address Line | 40793 DELTA DR
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City | NORTHVILLE
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State | MI
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Zip | 48168-3237
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Country | US
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Telephone | 248-513-0610
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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 | 2901020548
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.027567
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License Number State | IL
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