Provider Demographics
NPI:1083637185
Name:WARREN, ROBERT MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:WARREN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 SAN ANTONIO AVE
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-3018
Mailing Address - Country:US
Mailing Address - Phone:318-256-3641
Mailing Address - Fax:318-256-0898
Practice Address - Street 1:695 SAN ANTONIO AVE
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3018
Practice Address - Country:US
Practice Address - Phone:318-256-3641
Practice Address - Fax:318-256-0898
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA47441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1847445Medicaid
LA717644OtherINSURANCE PROVIDER ID