Provider Demographics
NPI:1376681999
Name:STINSON, WARREN KENT (DDS)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:KENT
Last Name:STINSON
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 1:113 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-2536
Mailing Address - Country:US
Mailing Address - Phone:865-475-2762
Mailing Address - Fax:865-475-7053
Practice Address - Street 1:113 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2536
Practice Address - Country:US
Practice Address - Phone:865-475-2762
Practice Address - Fax:865-475-7053
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS48031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice