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General NPI Number Information
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NPI Number | 1598320442
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Entity Type | Organization
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Legal Business Name | SAGE DENTAL, PA
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 1520 ROUTE 138
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City | WALL
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State | NJ
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Zip | 07719-3706
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Country | US
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Telephone | 732-528-6007
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Fax | 732-528-6898
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Provider Business Mailing Address
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Address Line | 1520 ROUTE 138
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City | WALL
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State | NJ
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Zip | 07719-3706
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Country | US
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Telephone | 732-528-6007
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Fax | 732-528-6898
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHRISTINA A FARIA
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Credential |
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Telephone | 732-528-6007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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