Provider Demographics
NPI:1871483842
Name:JOHNSON, SAVANNAH GRACE (DDS)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:GRACE
Last Name:JOHNSON
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 1:225 E IDAHO AVE STE 23
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3242
Mailing Address - Country:US
Mailing Address - Phone:575-524-8556
Mailing Address - Fax:575-523-8670
Practice Address - Street 1:225 E IDAHO AVE STE 23
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3242
Practice Address - Country:US
Practice Address - Phone:575-524-8556
Practice Address - Fax:575-523-8670
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDB-2025-01181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice