Provider Demographics
NPI:1538111869
Name:WARREN, DAVID D (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:WARREN
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 1:4141 CAMINO COYOTE STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-3001
Mailing Address - Country:US
Mailing Address - Phone:575-524-5812
Mailing Address - Fax:575-524-7710
Practice Address - Street 1:4141 CAMINO COYOTE STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-3001
Practice Address - Country:US
Practice Address - Phone:575-524-5812
Practice Address - Fax:575-524-7710
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM12671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM8884Medicare UPIN
NM46079Medicare UPIN