Provider Demographics
NPI:1538377510
Name:WILLIAM C. JOHNSTON, DDS (APDC)
Entity type:Organization
Organization Name:WILLIAM C. JOHNSTON, DDS (APDC)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-361-0381
Mailing Address - Street 1:1507 LAMY LN
Mailing Address - Street 2:STE A
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3804
Mailing Address - Country:US
Mailing Address - Phone:318-361-0381
Mailing Address - Fax:318-388-4598
Practice Address - Street 1:1507 LAMY LN
Practice Address - Street 2:STE A
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3804
Practice Address - Country:US
Practice Address - Phone:318-361-0381
Practice Address - Fax:318-388-4598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA38401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
824090OtherUNITED CONCORDIA
G6524OtherBLUE CROSS BLUE SHIELD