Individual
MR. MICHAEL BRUCE JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
1610 W C PL, RUSSELLVILLE, AR 72801-2705
(479) 968-8338
(479) 968-1688
Mailing address
1610 W C PL, RUSSELLVILLE, AR 72801-2705
(479) 968-8338
(479) 968-1688
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2643
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
545063
UNITED CONCORDIA PROV #
AZ
01
—
56547
BLUE CROSS PROVIDER #
AR
Enumeration date
11/29/2006
Last updated
07/09/2007
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