Provider Demographics
NPI:1235193681
Name:WARRING, ROBERT THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:WARRING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 EDWARDS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9740
Mailing Address - Country:US
Mailing Address - Phone:502-863-1505
Mailing Address - Fax:502-863-1505
Practice Address - Street 1:120 EDWARDS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9740
Practice Address - Country:US
Practice Address - Phone:502-863-1505
Practice Address - Fax:502-863-1505
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY61711223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60061710Medicaid