Provider Demographics
NPI:1831398767
Name:ROGER D. JOHNSON, DDS,PC
Entity type:Organization
Organization Name:ROGER D. JOHNSON, DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-851-9963
Mailing Address - Street 1:7525 PIONEER WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1165
Mailing Address - Country:US
Mailing Address - Phone:253-851-9963
Mailing Address - Fax:253-858-2425
Practice Address - Street 1:7525 PIONEER WAY STE 102
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1165
Practice Address - Country:US
Practice Address - Phone:253-851-9963
Practice Address - Fax:253-858-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4872122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty