Healthcare Provider Details

I. General information

NPI: 1811526239
Provider Name (Legal Business Name): SPENCER GARRETT WARREN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LENTZ DR STE 40
MADISON TN
37115
US

IV. Provider business mailing address

1327 CARDINAL AVE
NASHVILLE TN
37216-2310
US

V. Phone/Fax

Practice location:
  • Phone: 615-868-9057
  • Fax:
Mailing address:
  • Phone: 931-808-4592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.026384
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11809
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30.026384
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: