Sage Dental

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SAGE DENTAL

Practice address

5010 Garth Rd
#204
Baytown, TX 77521-2224

Phone

(972) 869-3789

Fax

(972) 869-3791

NPI assigned

Jun 9, 2011

Organization subpart

No

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

Authorized official

Name

Mary Pu

Title

Cfo

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652832000000",
    "number": "1457646267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 734753",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753734753",
            "telephone_number": "972-869-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5010 GARTH RD",
            "address_2": "#204",
            "city": "BAYTOWN",
            "state": "TX",
            "postal_code": "775212224",
            "telephone_number": "972-869-3789",
            "fax_number": "972-869-3791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-09",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A",
        "authorized_official_last_name": "PU",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2022; 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.