Provider Demographics
NPI:1932836509
Name:FONKERT, SAVANNA JOY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAVANNA
Middle Name:JOY
Last Name:FONKERT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 MERIDIAN DR
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-7561
Mailing Address - Country:US
Mailing Address - Phone:763-442-7457
Mailing Address - Fax:
Practice Address - Street 1:3685 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5218
Practice Address - Country:US
Practice Address - Phone:910-347-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC129341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice