Individual provider Active NPI

Bruce Roy Johnson, DDS

  • Public Health Dentistry
  • Tacoma, WA
National Provider Identifier
1629011069
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health DentistryTaxonomy code 1223D0001X
License
DE00006627 Issued in WA
Practice address
2209 E 32ND St
Tacoma, WA 98404-4922
Phone
(253) 593-0232
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health Dentistry 1223D0001X DE00006627 WA Primary

Addresses

Primary practice location

2209 E 32ND St
Tacoma, WA 98404-4922

Mailing address

17308 97TH Avenue CT E
Puyallup, WA 98375-9682
Phone (253) 840-5462

Other identifiers 3

IdentifierTypeStateIssuer
JO6014OtherWAREGENCE
91111635510OtherVAKITSAP PHYSICIAN SERVICE
0149889OtherWALABOR & INDUSTRIES

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DE00006627WAMDPublic Health Dentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1629011069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17308 97TH AVENUE CT E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983759682",
            "telephone_number": "253-840-5462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2209 E 32ND ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984044922",
            "telephone_number": "253-593-0232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRUCE",
        "middle_name": "ROY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "WA",
            "license": "DE00006627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "JO6014",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KITSAP PHYSICIAN SERVICE",
            "identifier": "91111635510",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0149889",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.