Healthcare Provider Details

I. General information

NPI: 1104318468
Provider Name (Legal Business Name): CHARLES A PAGE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2018
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 COVINGTON ST
YOUNGSTOWN OH
44510-1617
US

IV. Provider business mailing address

545 BRITTANY DR
STATE COLLEGE PA
16803-1422
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-3195
  • Fax: 330-480-1366
Mailing address:
  • Phone: 814-360-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12333
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: