Provider Demographics
NPI:1497245344
Name:SAUVAGE, PAUL RANDALL JR (DDS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RANDALL
Last Name:SAUVAGE
Suffix:JR
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 1:1210 22ND AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3535
Mailing Address - Country:US
Mailing Address - Phone:206-245-9173
Mailing Address - Fax:
Practice Address - Street 1:1210 22ND AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3535
Practice Address - Country:US
Practice Address - Phone:206-245-9173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WADE608784411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program