Provider Demographics
NPI:1255832663
Name:DAVID GAGE DMD PLLC
Entity Type:Organization
Organization Name:DAVID GAGE DMD PLLC
Other - Org Name:DAVID GAGE DMD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-757-0651
Mailing Address - Street 1:205 W FAIRHAVEN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-1062
Mailing Address - Country:US
Mailing Address - Phone:360-757-0651
Mailing Address - Fax:360-757-3741
Practice Address - Street 1:205 W FAIRHAVEN AVE STE B
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1062
Practice Address - Country:US
Practice Address - Phone:360-757-0651
Practice Address - Fax:360-757-3741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60472401261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1952719957Medicaid
WA1952719957OtherNPI