# SAGE DENTAL GROUP OF GEORGIA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sage Dental of Gainesville
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528779121
- **Authorized official:** CINDY ROARK DMD, MS (SVP & CHIEF CLINICAL OFFICER)
- **Authorized official phone:** (561) 999-9650

## Contact information

- **Practice address:** 1979 JESSE JEWELL PARKWAY, SUITE 102, GAINESVILLE, GA 30501
- **Practice address phone:** (561) 999-9650
- **Mailing address:** 951 BROKEN SOUND PKWY NW STE 250, BOCA RATON, FL 33487-3506
- **Mailing address phone:** (561) 999-9650

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 12/06/2022
- **Last updated:** 05/30/2023