MEDICARE: BRETT RANDAL WARN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5247	OK
2	122300000X	Dentist	5247	OK

General Provider Information

NPI Number	:	1295894004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT RANDAL WARN D.D.S.

Provider Business Mailing Address
First Line	:	5103 NW CACHE RD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-3415
Country	:	US
Telephone Number	:	580-248-4224
Fax Number	:	580-248-4299

Provider Business Practice Location Address
First Line	:	5103 NW CACHE RD
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-3415
Country	:	US
Telephone Number	:	580-248-4224
Fax Number	:	580-248-4299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	05/15/2025

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