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General NPI Number Information
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NPI Number | 1730863572
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Entity Type | Organization
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Legal Business Name | WARREN & HAGERMAN DENTAL PLLC
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 111 W WIGWAM BLVD STE A
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-4636
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Country | US
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Telephone | 602-692-8312
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Fax |
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Provider Business Mailing Address
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Address Line | 111 W WIGWAM BLVD STE A
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-4636
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Country | US
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Telephone | 623-935-9376
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. SHANNON JOANN WARREN
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Credential |
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Telephone | 623-935-9376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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