Provider Demographics
NPI:1396806733
Name:PAIGE E NANCE DDS PA
Entity type:Organization
Organization Name:PAIGE E NANCE DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-485-0023
Mailing Address - Street 1:5511 RAEFORD RD
Mailing Address - Street 2:STE 225
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3049
Mailing Address - Country:US
Mailing Address - Phone:910-485-0023
Mailing Address - Fax:910-485-0022
Practice Address - Street 1:5511 RAEFORD RD
Practice Address - Street 2:STE 225
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3049
Practice Address - Country:US
Practice Address - Phone:910-485-0023
Practice Address - Fax:910-485-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC018MAOtherNC HEALTH CHOICE #
NC1533457OtherUNITED CONCORDIA #
NC5903812Medicaid