Provider Demographics
NPI:1750608105
Name:DENNIS J PAGE PLLC
Entity type:Organization
Organization Name:DENNIS J PAGE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-552-7884
Mailing Address - Street 1:445 S FITNESS PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6828
Mailing Address - Country:US
Mailing Address - Phone:877-552-7884
Mailing Address - Fax:877-552-7885
Practice Address - Street 1:445 S FITNESS PL
Practice Address - Street 2:SUITE B
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6828
Practice Address - Country:US
Practice Address - Phone:877-552-7884
Practice Address - Fax:877-552-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-6970174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty