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Individual

DR. BRUCE ROY JOHNSON

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
2209 E 32ND ST, TACOMA, WA 98404-4922
(253) 593-0232
Mailing address
17308 97TH AVENUE CT E, PUYALLUP, WA 98375-9682
(253) 840-5462

Taxonomy

Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
DE00006627
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0149889
LABOR & INDUSTRIES
WA
01
91111635510
KITSAP PHYSICIAN SERVICE
VA
01
JO6014
REGENCE
WA
Enumeration date
06/14/2006
Last updated
07/08/2007
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