NPIMap

Organization Active NPI

Sage Dental Group of Georgia, LLC

  • Dentist
  • Buford, GA
National Provider Identifier
1508398447
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
3410 Buford Dr
E-780
Buford, GA 30519-4900
Phone
(678) 765-9930
Fax
(561) 431-8169
NPI assigned
Mar 30, 2017
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
(678) 765-9930

Specialties & licenses 1

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

Addresses

Primary practice location

3410 Buford Dr
E-780
Buford, GA 30519-4900

Mailing address

6600 Congress Ave Ste 150
Boca Raton, FL 33487-1213
Phone (678) 765-9930

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

Locations

3420 Buford Dr
Ste E780
Buford, GA 30519
Phone (404) 647-5794

3410 Buford Dr
#E780
Buford, GA 30519
Phone (678) 765-9930

NPI Registry JSON

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

{
    "created_epoch": "1490832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684368000000",
    "number": "1508398447",
    "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": "678-765-9930",
            "fax_number": "561-431-8169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3410 BUFORD DR",
            "address_2": "E-780",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305194900",
            "telephone_number": "678-765-9930",
            "fax_number": "561-431-8169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE DENTAL GROUP OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-30",
        "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": "678-765-9930",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buford, 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.