Provider Demographics
NPI:1790132496
Name:M PAIGE DDA & JM BRESSLER DDS AT FAIRBANKS LLC
Entity Type:Organization
Organization Name:M PAIGE DDA & JM BRESSLER DDS AT FAIRBANKS LLC
Other - Org Name:AFFORDABLE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:PAIGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-255-4143
Mailing Address - Street 1:503 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6236
Mailing Address - Country:US
Mailing Address - Phone:907-374-3888
Mailing Address - Fax:907-374-3889
Practice Address - Street 1:503 14TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-6236
Practice Address - Country:US
Practice Address - Phone:907-374-3888
Practice Address - Fax:907-374-3889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10355841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty