Provider Demographics
NPI:1922091479
Name:SAGE, MELVIN DOUGLAS (DDS)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:DOUGLAS
Last Name:SAGE
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 1:1768 WALNUT TREE LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-6979
Mailing Address - Country:US
Mailing Address - Phone:530-332-9711
Mailing Address - Fax:
Practice Address - Street 1:1046 MANGROVE AVE STE C
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3548
Practice Address - Country:US
Practice Address - Phone:530-777-0892
Practice Address - Fax:530-332-9711
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA176231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice