Healthcare Provider Details

I. General information

NPI: 1932115102
Provider Name (Legal Business Name): PAGE P BARDEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 MARKET PLACE BLVD
CUMMING GA
30041-7921
US

IV. Provider business mailing address

4947 FAIRHAVEN WAY NE
ROSWELL GA
30075-6110
US

V. Phone/Fax

Practice location:
  • Phone: 770-844-6771
  • Fax: 770-844-6686
Mailing address:
  • Phone: 404-272-2512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN010757
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN010757
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN010757
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: