Provider Demographics
NPI:1265545560
Name:PAGE, RICHARD MOE (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MOE
Last Name:PAGE
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:PO BOX 458
Mailing Address - Street 2:225 W OREGON AVE
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-0458
Mailing Address - Country:US
Mailing Address - Phone:541-895-4985
Mailing Address - Fax:541-895-2529
Practice Address - Street 1:225 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426
Practice Address - Country:US
Practice Address - Phone:541-895-4985
Practice Address - Fax:541-895-2529
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR50841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice