Provider Demographics
NPI:1780668616
Name:PAIGE, BENEGAL SPENCER SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENEGAL
Middle Name:SPENCER
Last Name:PAIGE
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:BENEGAL
Other - Middle Name:S
Other - Last Name:PAIGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PC
Mailing Address - Street 1:408 E MARKET ST
Mailing Address - Street 2:STE 206
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5261
Mailing Address - Country:US
Mailing Address - Phone:434-977-1206
Mailing Address - Fax:434-977-1206
Practice Address - Street 1:408 E MARKET ST
Practice Address - Street 2:STE 206
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5261
Practice Address - Country:US
Practice Address - Phone:434-977-1206
Practice Address - Fax:434-977-1206
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0013211Medicaid