Healthcare Provider Details

I. General information

NPI: 1851403158
Provider Name (Legal Business Name): STEPHEN R. WARREN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 HAMMONDS FERRY ROAD
BALTIMORE MD
21227
US

IV. Provider business mailing address

1435 PUTTY HILL AVE
TOWSON MD
21286-8026
US

V. Phone/Fax

Practice location:
  • Phone: 410-247-5566
  • Fax:
Mailing address:
  • Phone: 410-321-0034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6667
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: