# TRACY R. JOHNSON, DDS, PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376718957
- **Authorized official:** DR. TRACY R JOHNSON DDS (PRESIDENT/OWNER)
- **Authorized official phone:** (360) 895-8841

## Contact information

- **Practice address:** 2040 MITCHELL RD SE, PORT ORCHARD, WA 98366-4401
- **Practice address phone:** (360) 895-8841
- **Practice address fax:** (360) 895-9350
- **Mailing address:** 3377 BETHEL RD SE STE 107, PMB 184, PORT ORCHARD, WA 98366-5608
- **Mailing address phone:** (360) 895-8841
- **Mailing address fax:** (360) 895-9350

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DE00008961 | WA | Yes |

## Other

- **Enumeration date:** 04/24/2008
- **Last updated:** 04/24/2008