Provider Demographics
NPI:1326286709
Name:J SAM SAGE DDS PS
Entity Type:Organization
Organization Name:J SAM SAGE DDS PS
Other - Org Name:SAGE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:SAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-362-6677
Mailing Address - Street 1:9730 3RD AVE NE STE 209
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2023
Mailing Address - Country:US
Mailing Address - Phone:206-362-6677
Mailing Address - Fax:206-362-2586
Practice Address - Street 1:9730 3RD AVE NE STE 209
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2023
Practice Address - Country:US
Practice Address - Phone:206-362-6677
Practice Address - Fax:206-362-2586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty