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Organization
PERIODONTAL SPECIALTIES
Active
Organization
PERIODONTAL SPECIALTIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFERY JOHNSTON (PRESIDENT)
(586) 268-5520
Entity
Organization
Contact information
Practice address
8130 CONSTITUTION BLVD, STERLING HEIGHTS, MI 48313-3801
(586) 268-5520
Mailing address
8130 CONSTITUTION BLVD, STERLING HEIGHTS, MI 48313-3801
(586) 268-5520
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
13303
MI
Other
Enumeration date
02/05/2008
Last updated
02/05/2008
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