Provider Demographics
NPI:1093063463
Name:WARREN, REID PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:PATRICK
Last Name:WARREN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 N CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-1119
Mailing Address - Country:US
Mailing Address - Phone:803-635-6162
Mailing Address - Fax:803-635-1780
Practice Address - Street 1:124 N CONGRESS ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-1119
Practice Address - Country:US
Practice Address - Phone:803-635-6162
Practice Address - Fax:803-635-1780
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice