Individual
DR. DERRICK THOR JOHNSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2 NACO RD, BISBEE, AZ 85603
(520) 432-5371
(520) 432-6658
Mailing address
2 NACO RD, P.O. BOX 1898, BISBEE, AZ 85603
(520) 432-5371
(520) 432-6658
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2689
AZ
Other
Enumeration date
12/14/2006
Last updated
07/08/2007
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