1780668616 NPI number — DR. BENEGAL SPENCER PAIGE SR. DDS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780668616 NPI number — DR. BENEGAL SPENCER PAIGE SR. DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAIGE
Provider First Name:
BENEGAL
Provider Middle Name:
SPENCER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAIGE
Provider Other First Name:
BENEGAL
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS PC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780668616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 E MARKET ST
Provider Second Line Business Mailing Address:
STE 206
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22902-5261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-977-1206
Provider Business Mailing Address Fax Number:
434-977-1206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 E MARKET ST
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22902-5261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-977-1206
Provider Business Practice Location Address Fax Number:
434-977-1206
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  0401005400 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0013211 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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