Healthcare Provider Details

I. General information

NPI: 1265435770
Provider Name (Legal Business Name): WARREN J KAHN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 UPPER SHEEP PASTURE RD
SETAUKET NY
11733-1729
US

IV. Provider business mailing address

51 UPPER SHEEP PASTURE RD
SETAUKET NY
11733-1729
US

V. Phone/Fax

Practice location:
  • Phone: 631-751-2077
  • Fax:
Mailing address:
  • Phone: 631-751-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number27574
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: