Healthcare Provider Details

I. General information

NPI: 1972506822
Provider Name (Legal Business Name): MICHAEL PAIGE FOLCK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 LASKIN RD
VIRGINIA BEACH VA
23451-6079
US

IV. Provider business mailing address

1385 LASKIN ROAD
VIRGINIA BEACH VA
23451
US

V. Phone/Fax

Practice location:
  • Phone: 757-428-7440
  • Fax: 757-428-3452
Mailing address:
  • Phone: 757-428-7440
  • Fax: 757-428-3452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401003722
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: