Provider Demographics
NPI:1164149498
Name:WARRENTON FAMILY DENTIST LLC
Entity Type:Organization
Organization Name:WARRENTON FAMILY DENTIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:STOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:636-887-1994
Mailing Address - Street 1:505 INGRAM LN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-4429
Mailing Address - Country:US
Mailing Address - Phone:636-377-1233
Mailing Address - Fax:636-377-4049
Practice Address - Street 1:505 INGRAM LN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-4429
Practice Address - Country:US
Practice Address - Phone:636-377-1233
Practice Address - Fax:636-377-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental