Provider Demographics
NPI:1780916429
Name:PAIGE, JAMES G (RDH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:G
Last Name:PAIGE
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 CLYDESDALE WAY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-4630
Mailing Address - Country:US
Mailing Address - Phone:707-769-0646
Mailing Address - Fax:
Practice Address - Street 1:101 WESTCOAST RD
Practice Address - Street 2:
Practice Address - City:REDWAY
Practice Address - State:CA
Practice Address - Zip Code:95560-0769
Practice Address - Country:US
Practice Address - Phone:707-923-2783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8459124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist