Healthcare Provider Details

I. General information

NPI: 1144329855
Provider Name (Legal Business Name): DAVID W WARREN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 SW 80 STREET #112
MIAMI FL
33143
US

IV. Provider business mailing address

6601 SW 80 STREET SUITE 112
MIAMI FL
33143
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-6900
  • Fax:
Mailing address:
  • Phone: 305-661-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberFL6468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: