Individual
JOHN C PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
7734 AIRWAYS BLVD, SOUTHAVEN, MS 38671-5306
(662) 349-3838
(662) 349-5923
Mailing address
7734 AIRWAYS, SOUTHAVEN, MS 38671
(662) 349-3838
(662) 349-5923
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3116
MS
1223P0221X
Pediatric Dentistry
4237
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16596
—
TN
01
—
4013142
BCBS TN
TN
Enumeration date
12/29/2006
Last updated
07/08/2007
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