Sage Dentistry IV PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

00202525 Issued in CO

Legal business name

SAGE DENTISTRY IV PLLC

Doing business as

Family and Implant Dentistry of Lafayette

Practice address

1120 W South Boulder Rd
Suite 204
Lafayette, CO 80026-8951

Phone

(720) 638-2169

NPI assigned

Feb 9, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Sage Pollack, DMD

Title

Owner

Phone

(303) 494-1550

Specialties & licenses 1

Addresses

Other names 1

• Family and Implant Dentistry of Lafayette Doing business as

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

{
    "created_epoch": "1486598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486598400000",
    "number": "1154869121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 W SOUTH BOULDER RD",
            "address_2": "SUITE 204",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800268951",
            "telephone_number": "720-638-2169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 W SOUTH BOULDER RD",
            "address_2": "SUITE 204",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800268951",
            "telephone_number": "720-638-2169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE DENTISTRY IV PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-09",
        "last_updated": "2017-02-09",
        "status": "A",
        "authorized_official_last_name": "POLLACK",
        "authorized_official_first_name": "SAGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-494-1550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "00202525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family and Implant Dentistry of Lafayette",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David A Rutherford, DO
• Stephanie Terry Rutz, PA-C
• Justin B Rydberg, P.A.
• Natalie Ryder, MA
• Angelique Sabo I
• Anush S.a. Sahakian, MD, MPH
• Reed Salasnek, DO
• Kathryn Anne Salmeron, PHARMD
• Kayla Dyanne Salmon, LCSW
• Andrew Tracer Salonen

• General Practice Dentistry in Lafayette, CO
• Providers in Lafayette, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; 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.