NPIMap

Organization Active NPI

Sage Dental Group of Georgia LLC

  • Dentist
  • Marietta, GA
National Provider Identifier
1194260679
Registry record updated May 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SAGE DENTAL GROUP OF GEORGIA LLC
Practice address
4811 Lower Roswell Rd
Suite 108
Marietta, GA 30068-4372
Phone
(678) 905-6001
Fax
(561) 431-8169
NPI assigned
Dec 20, 2016
Last updated
May 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2023

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

Authorized official

Name
Jonathan Chang, DMD
Title
Chief Dental Director
Phone
(561) 999-9650

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

4811 Lower Roswell Rd
Suite 108
Marietta, GA 30068-4372

Mailing address

6600 Congress Ave Ste 150
Boca Raton, FL 33487-1213
Phone (678) 905-6001

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

NPI Registry JSON

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

{
    "created_epoch": "1482192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684368000000",
    "number": "1194260679",
    "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",
            "telephone_number": "678-905-6001",
            "fax_number": "561-431-8169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 LOWER ROSWELL RD",
            "address_2": "SUITE 108",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300684372",
            "telephone_number": "678-905-6001",
            "fax_number": "561-431-8169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE DENTAL GROUP OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-20",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "CHIEF DENTAL DIRECTOR",
        "authorized_official_telephone_number": "561-999-9650",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 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.