Healthcare Provider Details

I. General information

NPI: 1699611129
Provider Name (Legal Business Name): SAGE DENTAL GROUP OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4153 HWY 278 NE
COVINGTON GA
30014
US

IV. Provider business mailing address

6600 CONGRESS AVE STE 150
BOCA RATON FL
33487-1213
US

V. Phone/Fax

Practice location:
  • Phone: 561-999-9650
  • Fax: 561-431-2279
Mailing address:
  • Phone: 561-999-9650
  • Fax: 561-431-2279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: CINDY ROARK
Title or Position: SVP & CHIEF CLINICAL OFFICER
Credential: DMD, MS
Phone: 561-999-9650