Healthcare Provider Details

I. General information

NPI: 1518897040
Provider Name (Legal Business Name): SAGE FAMILY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 S MEMORIAL DR
TULSA OK
74145-9003
US

IV. Provider business mailing address

5424 S MEMORIAL DR STE C3
TULSA OK
74145-9003
US

V. Phone/Fax

Practice location:
  • Phone: 918-280-0880
  • Fax:
Mailing address:
  • Phone: 918-280-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KACY PHILLIPS
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 918-381-5229