Provider Demographics
NPI:1386822237
Name:WARREN, RUSSELL SCOTT (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:SCOTT
Last Name:WARREN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
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Mailing Address - Street 1:103 BURNETT CT
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3100
Mailing Address - Country:US
Mailing Address - Phone:254-399-9925
Mailing Address - Fax:254-399-9930
Practice Address - Street 1:103 BURNETT CT
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-3100
Practice Address - Country:US
Practice Address - Phone:254-399-9925
Practice Address - Fax:254-399-9930
Is Sole Proprietor?:No
Enumeration Date:2008-02-02
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX208781223S0112X
TXM9730204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery