Healthcare Provider Details

I. General information

NPI: 1396732293
Provider Name (Legal Business Name): ROGER NELSON WARREN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CLIFTON AVE
CLIFTON NJ
07013-3586
US

IV. Provider business mailing address

8 PHARIS PL
UPPER SADDLE RIVER NJ
07458-1408
US

V. Phone/Fax

Practice location:
  • Phone: 973-471-5600
  • Fax: 973-471-4652
Mailing address:
  • Phone: 201-327-4020
  • Fax: 201-327-1130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDI0009492
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: