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General NPI Number Information
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NPI Number | 1922299510
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Entity Type | Individual
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Provider Name | JOHN ROBERT JOHNSTON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 04/09/2017
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Provider Practice Location Address
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Address Line | 1425 S GREENFIELD RD STE 110
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City | MESA
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State | AZ
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Zip | 85206-5505
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Country | US
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Telephone | 480-900-5545
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Fax |
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Provider Business Mailing Address
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Address Line | 938 W ZION WAY
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City | CHANDLER
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State | AZ
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Zip | 85248-0202
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Country | US
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Telephone | 419-764-9147
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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 | 30 022635
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D009650
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License Number State | AZ
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