Healthcare Provider Details

I. General information

NPI: 1497245344
Provider Name (Legal Business Name): PAUL RANDALL SAUVAGE JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 22ND AVE E
SEATTLE WA
98112-3535
US

IV. Provider business mailing address

1210 22ND AVE E
SEATTLE WA
98112-3535
US

V. Phone/Fax

Practice location:
  • Phone: 206-245-9173
  • Fax:
Mailing address:
  • Phone: 206-245-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60878441
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: