Provider Demographics
NPI:1326197955
Name:PAGE, MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
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 1:2358 GENOA BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7366
Mailing Address - Country:US
Mailing Address - Phone:810-227-4111
Mailing Address - Fax:810-227-6434
Practice Address - Street 1:2358 GENOA BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7366
Practice Address - Country:US
Practice Address - Phone:810-227-4111
Practice Address - Fax:810-227-6434
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0121741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice