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General NPI Number Information
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NPI Number | 1629011069
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Entity Type | Individual
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Provider Name | BRUCE ROY JOHNSON DDS
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2209 E 32ND ST
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City | TACOMA
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State | WA
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Zip | 98404-4922
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Country | US
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Telephone | 253-593-0232
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Fax |
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Provider Business Mailing Address
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Address Line | 17308 97TH AVENUE CT E
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City | PUYALLUP
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State | WA
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Zip | 98375-9682
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Country | US
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Telephone | 253-840-5462
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | DE00006627
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License Number State | WA
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