MEDICARE: DR. CHERYL LEE JOHNSTON D.M.D.

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	39017	CA

General Provider Information

NPI Number	:	1780796821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL LEE JOHNSTON D.M.D.

Provider Business Mailing Address
First Line	:	31506 RAILROAD CANYON RD
Second Line	:	SUITE #3
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-9412
Country	:	US
Telephone Number	:	951-244-3011
Fax Number	:	951-244-0306

Provider Business Practice Location Address
First Line	:	31506 RAILROAD CANYON RD
Second Line	:	SUITE #3
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-9412
Country	:	US
Telephone Number	:	951-244-3011
Fax Number	:	951-244-0306

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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