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General NPI Number Information
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NPI Number | 1255832663
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Entity Type | Organization
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Legal Business Name | DAVID GAGE DMD PLLC
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 205 W FAIRHAVEN AVE STE B
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City | BURLINGTON
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State | WA
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Zip | 98233-1062
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Country | US
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Telephone | 360-757-0651
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Fax | 360-757-3741
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Provider Business Mailing Address
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Address Line | 205 W FAIRHAVEN AVE STE B
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City | BURLINGTON
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State | WA
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Zip | 98233-1062
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Country | US
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Telephone | 360-757-0651
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Fax | 360-757-3741
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID ALEXANDER GAGE
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Credential | DMD
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Telephone | 360-757-0651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE60472401
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License Number State | WA
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