Provider Demographics
NPI:1265109086
Name:SAUVAGE DDS PS
Entity type:Organization
Organization Name:SAUVAGE DDS PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAUVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-909-3863
Mailing Address - Street 1:1210 22ND AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3535
Mailing Address - Country:US
Mailing Address - Phone:206-498-1777
Mailing Address - Fax:
Practice Address - Street 1:953 E UNION ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122
Practice Address - Country:US
Practice Address - Phone:206-323-7659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAUVAGE, DDS, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-28
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental