Provider Demographics
NPI:1598896524
Name:PAIGE, TRAVIS T (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:T
Last Name:PAIGE
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 1:3379 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1031
Mailing Address - Country:US
Mailing Address - Phone:404-846-9100
Mailing Address - Fax:404-846-9769
Practice Address - Street 1:3379 PEACHTREE RD NE
Practice Address - Street 2:SUITE 850
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1031
Practice Address - Country:US
Practice Address - Phone:404-846-9100
Practice Address - Fax:404-846-9769
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCDN0111061223G0001X
GADN134171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice