Provider Demographics
NPI:1255865192
Name:PAGE, JOHN SPENCER
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SPENCER
Last Name:PAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5717 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5917
Mailing Address - Country:US
Mailing Address - Phone:214-826-6161
Mailing Address - Fax:214-821-2566
Practice Address - Street 1:5717 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5917
Practice Address - Country:US
Practice Address - Phone:214-826-6161
Practice Address - Fax:214-821-2566
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist