Provider Demographics
NPI:1710416466
Name:SAGE DENTAL GROUP OF GEORGIA LLC
Entity Type:Organization
Organization Name:SAGE DENTAL GROUP OF GEORGIA LLC
Other - Org Name:SAGE DENTAL OF MIDTOWN ATLANTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PROVIDER CREDENTIALING
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:561-999-9650
Mailing Address - Street 1:1080 PEACHTREE ST NE STE 3-5
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-6800
Mailing Address - Country:US
Mailing Address - Phone:404-685-8605
Mailing Address - Fax:404-855-4959
Practice Address - Street 1:1080 PEACHTREE ST NE STE 3-5
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-6800
Practice Address - Country:US
Practice Address - Phone:404-685-8605
Practice Address - Fax:404-855-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty