Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 30.024226 | OH |
NPI | 1194265686 |
---|---|
Provider Name | Dr. Geoffrey Johnston |
First Address | Apo, AP 96367-0030 |
Second Address | Apo, AP 96368-5142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2017 |
Last Update Date | 13/08/2021 |