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General NPI Number Information
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NPI Number | 1407916968
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Entity Type | Organization
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Legal Business Name | ROGER WARREN, DDS, PA
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1001 CLIFTON AVE SUITE 2A
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City | CLIFTON
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State | NJ
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Zip | 07013-3586
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Country | US
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Telephone | 973-471-5600
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Fax | 973-471-4652
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Provider Business Mailing Address
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Address Line | 1001 CLIFTON AVE SUITE 2A
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City | CLIFTON
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State | NJ
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Zip | 07013-3586
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Country | US
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Telephone | 973-471-5600
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Fax | 973-471-4652
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER NELSON WARREN
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Credential | D.D.S.
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Telephone | 973-471-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DI009492
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License Number State | NJ
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