MEDICARE: DR. DERRICK A JOHNSTON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12209722	IN
2	1223G0001X	General Practice Dentistry	12009722	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457481582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERRICK A JOHNSTON DDS

Provider Business Mailing Address
First Line	:	455 SHERIDAN RD
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-1315
Country	:	US
Telephone Number	:	317-773-1302
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 SHERIDAN RD
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-1315
Country	:	US
Telephone Number	:	317-773-1302
Fax Number	:	317-773-4214

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	01/20/2026

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