Provider Demographics
NPI:1497328397
Name:SAGE DENTAL GROUP OF GEORGIA LLC
Entity Type:Organization
Organization Name:SAGE DENTAL GROUP OF GEORGIA LLC
Other - Org Name:SAGE DENTAL OF NEWNAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NITTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-955-8234
Mailing Address - Street 1:6600 CONGRESS AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1213
Mailing Address - Country:US
Mailing Address - Phone:561-999-9650
Mailing Address - Fax:
Practice Address - Street 1:1605 HIGHWAY 34 E STE A1
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2191
Practice Address - Country:US
Practice Address - Phone:770-776-5871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty