Provider Demographics
NPI:1407170293
Name:WARCHOL, DAN G (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:G
Last Name:WARCHOL
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 1:515 E I30
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5408
Mailing Address - Country:US
Mailing Address - Phone:214-771-4603
Mailing Address - Fax:214-771-4610
Practice Address - Street 1:515 E I30
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5408
Practice Address - Country:US
Practice Address - Phone:214-771-4603
Practice Address - Fax:214-771-4610
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270581223G0001X
PADS037269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2849333-01Medicaid