Provider Demographics
NPI:1134260532
Name:PAGE, LAWRENCE D (DMD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:D
Last Name:PAGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ELMGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PROV
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-421-9350
Mailing Address - Fax:401-421-6450
Practice Address - Street 1:31 ELMGROVE AVE
Practice Address - Street 2:
Practice Address - City:PROV
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-421-9350
Practice Address - Fax:401-421-6450
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILP01970Medicaid