Provider Demographics
NPI:1356502009
Name:SAGER, CORY DARRELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:DARRELL
Last Name:SAGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 ICE CENTER LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6615
Mailing Address - Country:US
Mailing Address - Phone:267-307-1462
Mailing Address - Fax:
Practice Address - Street 1:380 ICE CENTER LN
Practice Address - Street 2:SUITE B
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6615
Practice Address - Country:US
Practice Address - Phone:267-307-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist