Provider Demographics
NPI:1649634643
Name:STEVEN L PAIGE DDS & LEROY HORTON DDS COVINGTON - PLLC
Entity type:Organization
Organization Name:STEVEN L PAIGE DDS & LEROY HORTON DDS COVINGTON - PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:DIMITRIOS
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-630-3500
Mailing Address - Street 1:16720 SE 271ST ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-7342
Mailing Address - Country:US
Mailing Address - Phone:253-630-3500
Mailing Address - Fax:253-630-3501
Practice Address - Street 1:16720 SE 271ST ST
Practice Address - Street 2:SUITE 211
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-7342
Practice Address - Country:US
Practice Address - Phone:253-630-3500
Practice Address - Fax:253-630-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000110481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty