Provider Demographics
NPI:1164401279
Name:WARR, JOHN PATRICK (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
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 1:2335 PONTIAC LAKE RD
Mailing Address - Street 2:STE. L
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2761
Mailing Address - Country:US
Mailing Address - Phone:248-706-2011
Mailing Address - Fax:
Practice Address - Street 1:2335 PONTIAC LAKE RD
Practice Address - Street 2:STE. L
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2761
Practice Address - Country:US
Practice Address - Phone:248-706-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI141621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice