MEDICARE: PAIGE P. WARREN DMD PSC

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	7194	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942579529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIGE P. WARREN DMD PSC

Provider Business Mailing Address
First Line	:	125 E MAIN ST
Second Line	:
City	:	PROVIDENCE
State	:	KY
Zip	:	42450-1268
Country	:	US
Telephone Number	:	270-667-7301
Fax Number	:	270-667-7630

Provider Business Practice Location Address
First Line	:	125 E MAIN ST
Second Line	:
City	:	PROVIDENCE
State	:	KY
Zip	:	42450-1268
Country	:	US
Telephone Number	:	270-667-7301
Fax Number	:	270-667-7630

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAIGE P WARREN
Credential	:	DMD
Telephone Number	:	270-667-7301

Provider Enumeration Date	:	12/28/2011
Last Update Date	:	12/28/2011

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