Individual
MATTHEW PARKER JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1825 NW HAWTHORNE AVE, GRANTS PASS, OR 97526-1043
(541) 479-6623
Mailing address
1825 NW HAWTHORNE AVE, GRANTS PASS, OR 97526-1043
(414) 796-6235
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D8582
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D8582
LICENSE
OR
Enumeration date
07/31/2006
Last updated
02/20/2024
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