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Sage Dental Of Lake Mary PLLC

Dentist in Lake Mary, FL. Organization (NPI-2).

NPI number1043674872
StatusActive
Last updated in NPPESApr 19, 2017

Details

NPI
1043674872
Entity type
Organization (NPI-2)
Legal business name
Sage Dental Of Lake Mary PLLC
Organization subpart
No
Enumeration date
Apr 7, 2016
Last updated
Apr 19, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist––Yes

Practice location

3801 W Lake Mary Blvd
Suite 111
Lake Mary, FL 32746-6159

Phone 407-936-3400 · Fax 561-431-8169

Mailing address

951 Broken Sound Pkwy
Suite 250
Boca Raton, FL 33487-3507

Phone 561-999-9650 · Fax 561-431-8169

Authorized official

Antonio Cruz
Chief Dental Director
5619999650

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