Provider Demographics
NPI:1912426347
Name:SAGE DENTISTRY II PLLC
Entity Type:Organization
Organization Name:SAGE DENTISTRY II PLLC
Other - Org Name:SAGE DENTISTRY II PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-910-1910
Mailing Address - Street 1:16205 W 64TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7401
Mailing Address - Country:US
Mailing Address - Phone:303-940-1910
Mailing Address - Fax:
Practice Address - Street 1:16205 W 64TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-7401
Practice Address - Country:US
Practice Address - Phone:303-940-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty