Provider Demographics
NPI:1558403238
Name:WHITE, SAGE LEE (DDS)
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:LEE
Last Name:WHITE
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 1:747 S PARADISE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3576
Mailing Address - Country:US
Mailing Address - Phone:435-586-9991
Mailing Address - Fax:435-586-9965
Practice Address - Street 1:747 S PARADISE CANYON RD
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3576
Practice Address - Country:US
Practice Address - Phone:435-586-9991
Practice Address - Fax:435-586-9965
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT983537119211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice