# PAGE DENTAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164689139
- **Authorized official:** JEFFREY S GIFFORD DMD (PRESIDENT)
- **Authorized official phone:** (928) 645-3206

## Contact information

- **Practice address:** 112 SIXTH AVENUE, PAGE, AZ 86040-1956
- **Practice address phone:** (928) 645-3206
- **Practice address fax:** (928) 645-9139
- **Mailing address:** PO BOX 1956, 112 SIXTH AVENUE, PAGE, AZ 86040-1956
- **Mailing address phone:** (928) 645-3206
- **Mailing address fax:** (928) 645-9139

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 3440 | AZ | — |
| 1223G0001X | General Practice Dentistry | 5411 | AZ | — |
| 1223G0001X | General Practice Dentistry | 7427 | AZ | Yes |

## Other

- **Enumeration date:** 05/19/2008
- **Last updated:** 12/17/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 084004 | — | AZ |
| 05 | — | 086274 | — | AZ |
| 05 | — | 283845 | — | AZ |