NPIMap

Organization Active NPI

Sage Dental Group of Georgia, LLC

Doing business as Sage Dental of Kennesaw

  • Dentist
  • Kennesaw, GA
National Provider Identifier
1083309850
Registry record updated Apr 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SAGE DENTAL GROUP OF GEORGIA, LLC
Doing business as
Sage Dental of Kennesaw
Practice address
1610 Ridenour Blvd NW Ste 102103
Kennesaw, GA 30152-4484
Phone
(561) 999-9650
NPI assigned
Apr 7, 2023
Last updated
Apr 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cindy Roark, DMD. MS
Title
SVP & Chief Clinical Officer
Phone
(561) 999-9650

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

1610 Ridenour Blvd NW Ste 102103
Kennesaw, GA 30152-4484

Mailing address

6600 Congress Ave Ste 150
Boca Raton, FL 33487-1213

Other names 1

  • Sage Dental of Kennesaw Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sage Dental Group of Georgia LLC25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Locations

1610 Ridenour Blvd NW
Ste 102103
Kennesaw, GA 30152

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680825600000",
    "number": "1083309850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 CONGRESS AVE STE 150",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334871213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 RIDENOUR BLVD NW STE 102103",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301524484",
            "telephone_number": "561-999-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE DENTAL GROUP OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-07",
        "last_updated": "2023-04-07",
        "certification_date": "2023-04-07",
        "status": "A",
        "authorized_official_last_name": "ROARK",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "SVP & CHIEF CLINICAL OFFICER",
        "authorized_official_telephone_number": "561-999-9650",
        "authorized_official_credential": "DMD. MS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sage Dental of Kennesaw",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.