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General NPI Number Information
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NPI Number | 1194256354
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Entity Type | Organization
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Legal Business Name | SAGE ENDODONTICS
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 260 LAMP AND LANTERN VLG
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City | TOWN AND COUNTRY
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State | MO
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Zip | 63017-8209
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Country | US
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Telephone | 636-220-3553
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Fax |
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Provider Business Mailing Address
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Address Line | 260 LAMP AND LANTERN VLG
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City | TOWN AND COUNTRY
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State | MO
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Zip | 63017-8209
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Country | US
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Telephone | 636-220-3553
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Fax |
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | DR. MARILEANA GARCIA CORRETJER
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Credential | DDS, MS
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Telephone | 636-220-3553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2010015739
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License Number State | MO
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