NPIMap

Cory Michael Johnston, DMD

Individual provider Active NPI General Practice Dentistry · Grants Pass, OR

NPI 1376863068 · NPPES record last updated Jan 2, 2015

Key facts

NPI
1376863068
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
9969 (OR)
Practice address
1215 NE 7TH St
Suite a
Grants Pass, OR 97526-1450
Phone
(541) 479-6623
NPI assigned
Jun 4, 2010
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
DEN-10208COMDGeneral Practice Dentistry
9969ORMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Johnston Dental Care LLC General Practice Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DEN-10208 CO
General Practice Dentistry 1223G0001X 9969 OR Yes

Addresses

Primary practice location

1215 NE 7TH St
Suite a
Grants Pass, OR 97526-1450

Mailing address

1215 NE 7TH St
Suite a
Grants Pass, OR 97526-1450
Phone (541) 479-6623

Other providers in Grants Pass, OR

All providers in Grants Pass, OR · General Practice Dentistry in Oregon

Sources for this page

Verify at the official NPI Registry.