Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5999 | WA |
NPI | 1043421365 |
---|---|
Provider Name | Dr. Craig Peter Johnston |
First Address | Issaquah, WA 98027-5342 |
Second Address | Issaquah, WA 98027-5342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 08/07/2007 |