Provider Demographics
NPI:1578976312
Name:ANGIE SAGE, DDS, PLLC
Entity Type:Organization
Organization Name:ANGIE SAGE, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTISTS
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-822-8381
Mailing Address - Street 1:999 E BASSE RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1801
Mailing Address - Country:US
Mailing Address - Phone:210-822-8381
Mailing Address - Fax:210-832-8724
Practice Address - Street 1:999 E BASSE RD
Practice Address - Street 2:SUITE 116
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1801
Practice Address - Country:US
Practice Address - Phone:210-822-8381
Practice Address - Fax:210-832-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111244304Medicaid