Provider Demographics
NPI:1982780425
Name:PAGE, GREGORY OLIVER (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:OLIVER
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 1:10 W 135TH ST
Mailing Address - Street 2:SUITE 1-E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-2602
Mailing Address - Country:US
Mailing Address - Phone:212-281-5775
Mailing Address - Fax:212-491-4573
Practice Address - Street 1:10 W 135TH ST
Practice Address - Street 2:SUITE 1-E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2602
Practice Address - Country:US
Practice Address - Phone:212-281-5775
Practice Address - Fax:212-491-4573
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist