Provider Demographics
NPI:1073788592
Name:BRETT R. WARN, D.D.S., INC.
Entity Type:Organization
Organization Name:BRETT R. WARN, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:RANDAL
Authorized Official - Last Name:WARN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-248-4224
Mailing Address - Street 1:502 NW SHERIDAN RD STE 5
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6505
Mailing Address - Country:US
Mailing Address - Phone:580-248-4224
Mailing Address - Fax:580-248-4299
Practice Address - Street 1:502 NW SHERIDAN RD STE 5
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6505
Practice Address - Country:US
Practice Address - Phone:580-248-4224
Practice Address - Fax:580-248-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty