Individual
NICHOLAS RYAN JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3400 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-5127
(925) 640-4205
Mailing address
3400 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-5127
(215) 662-3580
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS044765
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/26/2024
Last updated
12/02/2025
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