Provider Demographics
NPI:1730274598
Name:JOHNSTON, HUDSON S (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:HUDSON
Middle Name:S
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 N BEELINE HWY
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-3706
Mailing Address - Country:US
Mailing Address - Phone:928-474-4581
Mailing Address - Fax:928-474-4584
Practice Address - Street 1:712 N BEELINE HWY
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-3706
Practice Address - Country:US
Practice Address - Phone:928-474-4581
Practice Address - Fax:928-474-4584
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD66591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics