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NPI Code Detail

MEDICARE: SAGE DENTAL OF FT LAUDERDALE, PLLC

MEDICARE: SAGE DENTAL OF FT LAUDERDALE, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist

General Provider Information

NPI Number : 1013330430
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAGE DENTAL OF FT LAUDERDALE, PLLC
Provider Business Mailing Address
First Line : 951 BROKEN SOUND PKWY
Second Line : SUITE 250
City : BOCA RATON
State : FL
Zip : 33487
Country : US
Telephone Number : 561-999-9650
Fax Number : 561-431-8169
Provider Business Practice Location Address
First Line : 6171 N FEDERAL HWY
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33308-2227
Country : US
Telephone Number : 561-641-5610
Fax Number : 561-431-8169
Authorized Official
Title or Position : CHEIF DENTAL DIRECTOR
Name : ANTONIO CRUZ
Credential : DMD
Telephone Number : 561-999-9650
Provider Enumeration Date : 01/22/2014
Last Update Date : 02/24/2017

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