Provider Demographics
NPI:1316782535
Name:JOHNSTON, GARETT TAYLOR (DMD)
Entity type:Individual
Prefix:DR
First Name:GARETT
Middle Name:TAYLOR
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 N OCEAN SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-2752
Mailing Address - Country:US
Mailing Address - Phone:386-237-4998
Mailing Address - Fax:
Practice Address - Street 1:4 OLD KINGS RD N STE A
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8293
Practice Address - Country:US
Practice Address - Phone:386-445-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist