Provider Demographics
NPI:1215925540
Name:PAIGE, SARA J (DMD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:J
Last Name:PAIGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-4604
Mailing Address - Country:US
Mailing Address - Phone:502-379-4351
Mailing Address - Fax:502-459-9673
Practice Address - Street 1:3510 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4604
Practice Address - Country:US
Practice Address - Phone:502-379-4351
Practice Address - Fax:502-459-9673
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY81121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60002763Medicaid