MEDICARE: SAGE VIEW DENTAL INC

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1356119648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGE VIEW DENTAL INC

Provider Business Mailing Address
First Line	:	174 ASH ST N
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5232
Country	:	US
Telephone Number	:	208-734-3148
Fax Number	:	208-736-3907

Provider Business Practice Location Address
First Line	:	174 ASH ST N
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5232
Country	:	US
Telephone Number	:	208-734-3148
Fax Number	:	208-736-3907

Authorized Official
Title or Position	:	OWNER
Name	:	MONTE P WILLIAMS
Credential	:	DDS
Telephone Number	:	208-734-3148

Provider Enumeration Date	:	12/15/2023
Last Update Date	:	06/20/2024

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