Provider Demographics
NPI:1932115102
Name:BARDEN, PAGE P (DDS)
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:P
Last Name:BARDEN
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 1:4947 FAIRHAVEN WAY NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6110
Mailing Address - Country:US
Mailing Address - Phone:404-272-2512
Mailing Address - Fax:
Practice Address - Street 1:1024 MARKET PLACE BLVD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7921
Practice Address - Country:US
Practice Address - Phone:770-844-6771
Practice Address - Fax:770-844-6686
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0107571223P0300X, 122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00882934DMedicaid