Provider Demographics
NPI:1336127778
Name:SAGUE, EDWARD NORMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:NORMAN
Last Name:SAGUE
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 1:5285 SAPPHIRE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5063
Mailing Address - Country:US
Mailing Address - Phone:609-827-0960
Mailing Address - Fax:
Practice Address - Street 1:5285 SAPPHIRE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5063
Practice Address - Country:US
Practice Address - Phone:609-827-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD088411223G0001X
NJ138491223G0001X
MA167731223G0001X
MD88411223G0001X
MADN167731223G0001X
PADS023057L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice