MEDICARE: ROGER D. JOHNSON, DDS,PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4872	WA

General Provider Information

NPI Number	:	1831398767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGER D. JOHNSON, DDS,PC

Provider Business Mailing Address
First Line	:	7525 PIONEER WAY STE 102
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1165
Country	:	US
Telephone Number	:	253-851-9963
Fax Number	:	253-858-2425

Provider Business Practice Location Address
First Line	:	7525 PIONEER WAY STE 102
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1165
Country	:	US
Telephone Number	:	253-851-9963
Fax Number	:	253-858-2425

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROGER DALE JOHNSON
Credential	:	DDS
Telephone Number	:	253-851-9963

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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