Healthcare Provider Details

I. General information

NPI: 1598895088
Provider Name (Legal Business Name): RIVER VALLEY DENTAL, GARY L. WARREN D.D.S, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 TIKI LN
LANCASTER OH
43130-8729
US

IV. Provider business mailing address

1579 TIKI LN
LANCASTER OH
43130-8729
US

V. Phone/Fax

Practice location:
  • Phone: 614-878-9562
  • Fax:
Mailing address:
  • Phone: 614-878-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: GARRY WARREN
Title or Position: DDS
Credential:
Phone: 614-878-9562