=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316811599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WARREN GROUP DENTAL ASSOCIATES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2025
-----------------------------------------------------
Last Update Date | 10/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21635 RYAN RD STE 100
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48091-2792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-800-0055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21635 RYAN RD STE 100
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48091-2792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGIONAL MANAGER
-----------------------------------------------------
Name | SHAMS HAMAMA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-910-4819
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------