Healthcare Provider Details

I. General information

NPI: 1427989987
Provider Name (Legal Business Name): SAVANNAH KHEMMORO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25627 WOODWARD AVE
ROYAL OAK MI
48067-0907
US

IV. Provider business mailing address

3828 MYSTIC VALLEY DR
BLOOMFIELD HILLS MI
48302-1437
US

V. Phone/Fax

Practice location:
  • Phone: 248-582-6608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603119
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: