Provider Demographics
NPI:1821026030
Name:JOHNSON, SAMANTHA KAYE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:KAYE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:BRITT
Other - Last Name:KAYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3823 ROSWELL RD STE 205
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6295
Mailing Address - Country:US
Mailing Address - Phone:770-973-9275
Mailing Address - Fax:770-579-4699
Practice Address - Street 1:3823 ROSWELL RD STE 205
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6295
Practice Address - Country:US
Practice Address - Phone:707-973-9275
Practice Address - Fax:770-579-4699
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0499031223G0001X
CA531311223G0001X
TX245111223G0001X
GADN0149441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice