Provider Demographics
NPI:1477067106
Name:SAGE M. HUMPHRIES, DDS., MS., INC.
Entity Type:Organization
Organization Name:SAGE M. HUMPHRIES, DDS., MS., INC.
Other - Org Name:H2 DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAGE
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:714-997-5961
Mailing Address - Street 1:6505 ROSEMEAD BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-3543
Mailing Address - Country:US
Mailing Address - Phone:562-942-1062
Mailing Address - Fax:
Practice Address - Street 1:6505 ROSEMEAD BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-3543
Practice Address - Country:US
Practice Address - Phone:562-942-1062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty