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1386394898
DALLAS DOMINIQUE JOHNSTON
GRAND RAPIDS, MI
NPI
1386394898
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: MI 5601011845)
Enumeration Date
2022-03-27
Last Update Date
2023-10-09
Business Address
DALLAS DOMINIQUE JOHNSTON PA
100 MICHIGAN ST NE # MC019
GRAND RAPIDS, MI 49503-2560
Phone number: 616-486-0310
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Mailing Address
DALLAS DOMINIQUE JOHNSTON PA
100 MICHIGAN ST NE # MC845
GRAND RAPIDS, MI 49503-2560
Phone number:
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