Provider Demographics
NPI:1407916968
Name:ROGER WARREN, DDS, PA
Entity Type:Organization
Organization Name:ROGER WARREN, DDS, PA
Other - Org Name:CLIFTON PERIODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-471-5600
Mailing Address - Street 1:1001 CLIFTON AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3586
Mailing Address - Country:US
Mailing Address - Phone:973-471-5600
Mailing Address - Fax:973-471-4652
Practice Address - Street 1:1001 CLIFTON AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3586
Practice Address - Country:US
Practice Address - Phone:973-471-5600
Practice Address - Fax:973-471-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0094921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty