Provider Demographics
NPI:1275612863
Name:GAGE, JOHN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:GAGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 N STEMMONS ST
Mailing Address - Street 2:SUITE100
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-9307
Mailing Address - Country:US
Mailing Address - Phone:940-458-9000
Mailing Address - Fax:940-458-9001
Practice Address - Street 1:551 N STEMMONS ST
Practice Address - Street 2:SUITE100
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266-9307
Practice Address - Country:US
Practice Address - Phone:940-458-9000
Practice Address - Fax:940-458-9001
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice