Basic Information
Provider Information | |||||||||
NPI: | 1184610057 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOLBERT | ||||||||
FirstName: | PAIGE | ||||||||
MiddleName: | TURNER | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DDS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TURNER | ||||||||
OtherFirstName: | ELLISON | ||||||||
OtherMiddleName: | PAIGE | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1612 HUGUENOT RD | ||||||||
Address2: |   | ||||||||
City: | MIDLOTHIAN | ||||||||
State: | VA | ||||||||
PostalCode: | 23113 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8047949789 | ||||||||
FaxNumber: | 8044191059 | ||||||||
Practice Location | |||||||||
Address1: | 14001 CHARTER PARK DR. | ||||||||
Address2: |   | ||||||||
City: | MIDLOTHIAN | ||||||||
State: | VA | ||||||||
PostalCode: | 23114 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8043791011 | ||||||||
FaxNumber: | 8044170259 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/26/2005 | ||||||||
LastUpdateDate: | 08/23/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/23/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223E0200X | 0401412283 | VA | Y |   | Dental Providers | Dentist | Endodontics |
No ID Information.