Provider Demographics
NPI:1326572751
Name:WARREN & LAW DENTAL, LLC
Entity Type:Organization
Organization Name:WARREN & LAW DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:575-524-5812
Mailing Address - Street 1:4141 CAMINO COYOTE STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-3001
Mailing Address - Country:US
Mailing Address - Phone:575-524-5812
Mailing Address - Fax:575-524-7710
Practice Address - Street 1:4141 CAMINO COYOTE STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-3001
Practice Address - Country:US
Practice Address - Phone:575-524-5812
Practice Address - Fax:575-524-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD12371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty