Individual
DALLAS DOMINIQUE JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
100 MICHIGAN ST NE # MC019, GRAND RAPIDS, MI 49503-2560
(616) 486-0310
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601011845
MI
Other
Enumeration date
03/27/2022
Last updated
10/09/2023
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