Individual
DR. TRACY R JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9101 BRIDGEPORT WAY SW, BLDG B2, LAKEWOOD, WA 98499-2419
(253) 584-0858
(253) 584-1446
Mailing address
9101 BRIDGEPORT WAY SW STE B2, LAKEWOOD, WA 98499-2419
(253) 584-0858
(253) 584-1446
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
13638
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DE00008961
WA
Other
Enumeration date
11/09/2005
Last updated
03/20/2026
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