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 1:2970 PEACHTREE RD NW STE 660
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2115
Mailing Address - Country:US
Mailing Address - Phone:404-237-6464
Mailing Address - Fax:404-266-8567
Practice Address - Street 1:2970 PEACHTREE RD NW STE 660
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2115
Practice Address - Country:US
Practice Address - Phone:404-237-6464
Practice Address - Fax:404-266-8567
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0149441223G0001X
CA531311223G0001X
TX245111223G0001X
GA14944122300000X
NY0499031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist