MEDICARE: SAMANTHA KAYE JOHNSON, DDS, PC FAMILY DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1750119996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMANTHA KAYE JOHNSON, DDS, PC FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	2970 PEACHTREE RD NW STE 660
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2115
Country	:	US
Telephone Number	:	404-237-6464
Fax Number	:

Provider Business Practice Location Address
First Line	:	2970 PEACHTREE RD NW STE 660
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2115
Country	:	US
Telephone Number	:	404-237-6464
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SAMANTHA KAYE JOHNSON
Credential	:	DDS
Telephone Number	:	917-853-7082

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/22/2024

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