Provider Demographics
NPI:1336184175
Name:SAGMAN, MICHAEL ELLIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ELLIS
Last Name:SAGMAN
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 1:732 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 903
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4218
Mailing Address - Country:US
Mailing Address - Phone:757-873-3600
Mailing Address - Fax:757-873-6690
Practice Address - Street 1:732 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 903
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4218
Practice Address - Country:US
Practice Address - Phone:757-873-3600
Practice Address - Fax:757-873-6690
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010044801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice