Provider Demographics
NPI:1629193651
Name:PAGE, STEPHEN B (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:B
Last Name:PAGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4953 CASTELLO DRIVE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103
Mailing Address - Country:US
Mailing Address - Phone:239-263-2122
Mailing Address - Fax:239-262-5856
Practice Address - Street 1:4953 CASTELLO DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-8927
Practice Address - Country:US
Practice Address - Phone:239-263-2122
Practice Address - Fax:239-262-5856
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL83651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice