Provider Demographics
NPI:1598290819
Name:SAGE M. HUMPHRIES, DDS., MS., INC.
Entity Type:Organization
Organization Name:SAGE M. HUMPHRIES, DDS., MS., INC.
Other - Org Name:H2 PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAGE
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-997-5961
Mailing Address - Street 1:805 W LA VETA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3929
Mailing Address - Country:US
Mailing Address - Phone:714-532-9700
Mailing Address - Fax:714-532-9766
Practice Address - Street 1:805 W LA VETA AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3929
Practice Address - Country:US
Practice Address - Phone:714-532-9700
Practice Address - Fax:714-532-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty