Active NPI
Bruce Roy Johnson, DDS
- Public Health Dentistry
- Tacoma, WA
National Provider Identifier
1629011069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health Dentistry
- License
- DE00006627
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| JO6014 | Other | WA | REGENCE |
| 91111635510 | Other | VA | KITSAP PHYSICIAN SERVICE |
| 0149889 | Other | WA | LABOR & 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
| License | State | Type | Specialty |
|---|---|---|---|
| DE00006627 | WA | MD | Public 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.