Provider Demographics
NPI:1225467632
Name:DARRYL A. WARREN, DDS, PA
Entity Type:Organization
Organization Name:DARRYL A. WARREN, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-633-1715
Mailing Address - Street 1:611 MCCARTHY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562
Mailing Address - Country:US
Mailing Address - Phone:252-633-1715
Mailing Address - Fax:252-636-2898
Practice Address - Street 1:611 MCCARTHY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562
Practice Address - Country:US
Practice Address - Phone:252-633-1715
Practice Address - Fax:252-636-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998924Medicaid
NC662196OtherTRICARE