Provider Demographics
NPI:1275910978
Name:PAGANO, MICHAEL STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:PAGANO
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 1:10120 W BROAD ST STE I
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6709
Mailing Address - Country:US
Mailing Address - Phone:804-625-4064
Mailing Address - Fax:804-625-4066
Practice Address - Street 1:10120 W BROAD ST STE I
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6709
Practice Address - Country:US
Practice Address - Phone:804-625-4064
Practice Address - Fax:804-625-4066
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014159991223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice