Provider Demographics
NPI:1114533486
Name:MACGREGOR, SAVANNAH ROSE (DDS)
Entity type:Individual
Prefix:DR
First Name:SAVANNAH
Middle Name:ROSE
Last Name:MACGREGOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:ROSE
Other - Last Name:MARSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2237 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8050
Mailing Address - Country:US
Mailing Address - Phone:907-600-5001
Mailing Address - Fax:907-600-5068
Practice Address - Street 1:2237 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8050
Practice Address - Country:US
Practice Address - Phone:907-600-5001
Practice Address - Fax:907-600-5068
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2025-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK165471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1709833Medicaid