| NPI | 1285044529 |
|---|---|
| Doing Business As | SAGE DENTAL |
| Entity Type | Organization |
| Authorized Contact | KYLE JAMES SIEMEN Dentist/President 208-233-6912 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D3403) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2014-05-07 |