Basic Information
| Provider Information | |||||||||
| NPI: | 1700303963 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAGE DENTAL OF DADELAND PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 BROKEN SOUND PKWY STE 250 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334873506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619999650 | ||||||||
| FaxNumber: | 5614318169 | ||||||||
| Practice Location | |||||||||
| Address1: | 7714 NORTH KENDALL DRIVE | ||||||||
| Address2: | |||||||||
| City: | KENDALL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7868704665 | ||||||||
| FaxNumber: | 3054153001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2017 | ||||||||
| LastUpdateDate: | 08/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | CRUZ | ||||||||
| AuthorizedOfficialFirstName: | ANTONIO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF DENTAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5619999650 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DMD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DN12876 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.