Provider Demographics
NPI:1366462236
Name:PAGE, MARC JEFFREY (DMD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:JEFFREY
Last Name:PAGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ELMGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4103
Mailing Address - Country:US
Mailing Address - Phone:401-421-9350
Mailing Address - Fax:401-421-6450
Practice Address - Street 1:31 ELMGROVE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4103
Practice Address - Country:US
Practice Address - Phone:401-421-9350
Practice Address - Fax:401-421-6450
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMP01974Medicaid