Sage Dental of Lebanon, PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SAGE DENTAL OF LEBANON, PLLC

Practice address

1443 W Main St Ste 200
Lebanon, TN 37087-7026

Phone

(561) 999-9650

NPI assigned

Jan 30, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Cindy Roark

Title

SVP & Chief Clinical Officer

Phone

(561) 999-9650

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1706572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706572800000",
    "number": "1093578429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 931622",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311931622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1443 W MAIN ST STE 200",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370877026",
            "telephone_number": "561-999-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE DENTAL OF LEBANON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-30",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "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_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Lebanon, TN
• Providers in Lebanon, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; 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.