John Douglas Page, DMD
Individual provider Active NPI Dentist · Tompkinsville, KY
NPI 1043433758 · NPPES record last updated May 19, 2011
Key facts
- NPI
- 1043433758
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 7984 (KY)
- Practice address
- 204 W Paige Street
Tompkinsville, KY 42167 - Phone
- (270) 487-5196
- Fax
- (270) 487-5196
- NPI assigned
- Apr 11, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7984 | KY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 7984 | KY | |
| Dentist | 122300000X | 7984 | KY | Yes |
Addresses
Primary practice location
204 W Paige Street
Tompkinsville, KY 42167
Mailing address
204 W Paige Street
PO Box 249
Tompkinsville, KY 42167
Phone (270) 487-5196
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60002268 | Medicaid | KY |
Other providers in Tompkinsville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.