Sage Dental of Mt Dora PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SAGE DENTAL OF MT DORA PLLC

Practice address

17435 US Highway 441 Ste 107
Mount Dora, FL 32757-6750

Phone

(561) 999-9650

NPI assigned

Jun 1, 2021

Organization subpart

No

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

Authorized official

Name

Cindy Roark, DMD, MS, COO

Title

President

Phone

(561) 999-9650

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1306412390",
    "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": "561-999-9650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17435 US HIGHWAY 441 STE 107",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576750",
            "telephone_number": "561-999-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE DENTAL OF MT DORA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-01",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A",
        "authorized_official_last_name": "ROARK",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-999-9650",
        "authorized_official_credential": "DMD, MS, COO"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Russman, LCSW
• Laura Russo, MA, BCBA
• Alyssa Rutzke
• Shinumol Sabu, APRN
• Gisela Sadler, LPN
• Laura June Sanchez
• Jennifer Sandler, PH.D.
• Amber Renae Sanford, ARNP
• Edmarie Santiago Vargas
• Ericka Santiago

• Dentist in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.