Provider Demographics
NPI:1538532569
Name:THOMAS C. JOHNSTON D.D.S., P.C.
Entity type:Organization
Organization Name:THOMAS C. JOHNSTON D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-475-4646
Mailing Address - Street 1:5685 S 1475 E
Mailing Address - Street 2:#4A
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4716
Mailing Address - Country:US
Mailing Address - Phone:801-475-4646
Mailing Address - Fax:
Practice Address - Street 1:5685 S 1475 E
Practice Address - Street 2:#4A
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4716
Practice Address - Country:US
Practice Address - Phone:801-475-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142246335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier