Provider Demographics
NPI:1689687642
Name:PAIGE, JASON RANDOLPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RANDOLPH
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 1:2928 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-3600
Mailing Address - Country:US
Mailing Address - Phone:804-321-4065
Mailing Address - Fax:804-321-6493
Practice Address - Street 1:2928 NORTH AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-3600
Practice Address - Country:US
Practice Address - Phone:804-321-4065
Practice Address - Fax:804-321-6493
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist