Provider Demographics
NPI:1194932665
Name:JOHNSTON, BILL WILLIAM C (DDS)
Entity type:Individual
Prefix:DR
First Name:BILL WILLIAM
Middle Name:C
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 LAMY LN
Mailing Address - Street 2:STE A
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3804
Mailing Address - Country:US
Mailing Address - Phone:318-361-0381
Mailing Address - Fax:318-388-4598
Practice Address - Street 1:1507 LAMY LN
Practice Address - Street 2:STE A
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3804
Practice Address - Country:US
Practice Address - Phone:318-361-0381
Practice Address - Fax:318-388-4598
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0038401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice