MEDICARE: MICHAEL PAIGE FOLCK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401003722	VA

General Provider Information

NPI Number	:	1972506822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL PAIGE FOLCK DDS

Provider Business Mailing Address
First Line	:	1385 LASKIN ROAD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451
Country	:	US
Telephone Number	:	757-428-7440
Fax Number	:	757-428-3452

Provider Business Practice Location Address
First Line	:	1385 LASKIN RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6079
Country	:	US
Telephone Number	:	757-428-7440
Fax Number	:	757-428-3452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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