Provider Demographics
NPI:1558614115
Name:SAGER DENTAL GROUP
Entity Type:Organization
Organization Name:SAGER DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-579-5998
Mailing Address - Street 1:380 ICE CENTER LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-586-9871
Mailing Address - Fax:406-522-0586
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:59718-5970
Practice Address - Country:US
Practice Address - Phone:406-586-9871
Practice Address - Fax:406-522-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty