Healthcare Provider Details

I. General information

NPI: 1548366446
Provider Name (Legal Business Name): MARY RITA WARREN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 FOREST TRL
NEW BRAUNFELS TX
78132-4624
US

IV. Provider business mailing address

461 FOREST TRL
NEW BRAUNFELS TX
78132-4624
US

V. Phone/Fax

Practice location:
  • Phone: 830-625-2583
  • Fax: 830-625-2583
Mailing address:
  • Phone: 830-625-2583
  • Fax: 830-625-2583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number15683
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: