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General NPI Number Information
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NPI Number | 1669626495
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Entity Type | Organization
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Legal Business Name | MICHAEL L. GAGE, D.D.S.
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Dates
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Enumeration Date | 11/06/2008
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 2520 N ALDER ST
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City | TACOMA
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State | WA
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Zip | 98406-6632
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Country | US
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Telephone | 253-759-5414
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Fax | 253-756-6860
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Provider Business Mailing Address
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Address Line | 2520 N ALDER ST
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City | TACOMA
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State | WA
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Zip | 98406-6632
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Country | US
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Telephone | 253-759-5414
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Fax | 253-756-6860
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Authorized Official
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Title or Position | OWENER
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Name | MICHAEL L GAGE
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Credential | D.D.S.
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Telephone | 253-759-5414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4344
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License Number State | WA
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