NPIMap

Organization Active NPI

Sage Dental of Port St Lucie West, PLLC

  • Dentist
  • Port St Lucie, FL
National Provider Identifier
1205193539
Registry record updated Apr 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN6483 Issued in FL
Legal business name
SAGE DENTAL OF PORT ST LUCIE WEST, PLLC
Practice address
1722 SW Saint Lucie West Blvd
Port St Lucie, FL 34986-2504
Phone
(772) 337-8600
Fax
(561) 431-8169
NPI assigned
Apr 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2017

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

Authorized official

Name
Dr. Antonio Cruz, DMD
Title
Chief Dental Director
Phone
(561) 999-9650

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DN6483 FL Primary

Addresses

Primary practice location

1722 SW Saint Lucie West Blvd
Port St Lucie, FL 34986-2504

Mailing address

951 Broken Sound Pkwy
Suite 250
Boca Raton, FL 33487
Phone (561) 999-9650

National Provider Directory

National Provider Directory

Locations

1722 SW Saint Lucie West Blvd
Port St Lucie, FL 34986
Phone (772) 337-8600

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1334102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492560000000",
    "number": "1205193539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 BROKEN SOUND PKWY",
            "address_2": "SUITE 250",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "33487",
            "telephone_number": "561-999-9650",
            "fax_number": "561-431-8169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1722 SW SAINT LUCIE WEST BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349862504",
            "telephone_number": "772-337-8600",
            "fax_number": "561-431-8169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE DENTAL OF PORT ST LUCIE WEST, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-11",
        "last_updated": "2017-04-19",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "CHIEF DENTAL DIRECTOR",
        "authorized_official_telephone_number": "561-999-9650",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN6483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 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.