Provider Demographics
NPI:1467456749
Name:WARREN, THOMAS MALCOLM (DMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MALCOLM
Last Name:WARREN
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 1:2655A OLD SHELL RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-2929
Mailing Address - Country:US
Mailing Address - Phone:251-476-2848
Mailing Address - Fax:251-476-9868
Practice Address - Street 1:2655A OLD SHELL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-2929
Practice Address - Country:US
Practice Address - Phone:251-476-2848
Practice Address - Fax:251-476-9868
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-02
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
AL3205LN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL738366OtherUNITED CONCORDIA NUMBER
AL738366OtherUNITED CONCORDIA NUMBER