Provider Demographics
NPI:1093823163
Name:WARR, GARY JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOHN
Last Name:WARR
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 1:21701 W 11 MILE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076
Mailing Address - Country:US
Mailing Address - Phone:248-353-6688
Mailing Address - Fax:248-353-6689
Practice Address - Street 1:21701 W 11 MILE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076
Practice Address - Country:US
Practice Address - Phone:248-353-6688
Practice Address - Fax:248-353-6689
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist