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NPI Code Detail

MEDICARE: SAGE DENTAL OF GARDENDALE, PLLC

MEDICARE: SAGE DENTAL OF GARDENDALE, PLLC
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
1122300000XDentist

General Provider Information

NPI Number : 1881430478
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAGE DENTAL OF GARDENDALE, PLLC
Provider Business Mailing Address
First Line : 6600 CONGRESS AVE STE 150
Second Line :
City : BOCA RATON
State : FL
Zip : 33487-1213
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 655 FIELDSTOWN RD
Second Line :
City : GARDENDALE
State : AL
Zip : 35071-2411
Country : US
Telephone Number : 205-386-3041
Fax Number :
Authorized Official
Title or Position : SVP & CHIEF CLINICAL OFFICER
Name : CINDY ROARK
Credential :
Telephone Number : 561-999-9650
Provider Enumeration Date : 07/03/2024
Last Update Date : 07/03/2024

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