Organization
PADUCAH PEDIATRIC DENTISTRY PSC
Active
Other names
J.D. Johnston PSC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES DENNIS JOHNSTON D.D.S. (PRESIDENT)
(270) 554-3131
Entity
Organization
Contact information
Practice address
2850 LONE OAK RD, SUITE 1, PADUCAH, KY 42003-8043
(270) 554-3131
(270) 554-0124
Mailing address
2850 LONE OAK RD, SUITE 1, PADUCAH, KY 42003-8043
(270) 554-3131
(270) 554-0124
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
4218
KY
1223P0221X
Pediatric Dentistry
Primary
4218
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45002524
—
KY
05
—
60042181
—
KY
Enumeration date
07/30/2006
Last updated
04/24/2008
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