Provider Demographics
NPI:1114008844
Name:PAGE, MARK E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:PAGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 VERDUGO BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1414
Mailing Address - Country:US
Mailing Address - Phone:818-790-2407
Mailing Address - Fax:818-790-2490
Practice Address - Street 1:1808 VERDUGO BLVD STE 207
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1414
Practice Address - Country:US
Practice Address - Phone:818-790-2407
Practice Address - Fax:818-790-2490
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA463181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice