Healthcare Provider Details

I. General information

NPI: 1619894540
Provider Name (Legal Business Name): JACOB RUBEN WARR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 POTOMAC CIR
AURORA CO
80011-6714
US

IV. Provider business mailing address

3257 S PARKER RD APT 4412
DENVER CO
80014-3239
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-1234
  • Fax:
Mailing address:
  • Phone: 801-900-1841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN.00206635
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: