Provider Demographics
NPI:1861014334
Name:PAGE PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:PAGE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREE-ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:614-215-9488
Mailing Address - Street 1:5699 INNOVATION DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-3312
Mailing Address - Country:US
Mailing Address - Phone:614-215-9488
Mailing Address - Fax:614-215-9844
Practice Address - Street 1:5699 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3312
Practice Address - Country:US
Practice Address - Phone:614-215-9488
Practice Address - Fax:614-215-9844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0178225Medicaid