Provider Demographics
NPI:1598786071
Name:WARREN, ANTHONY JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAMES
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 1:780 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4304
Mailing Address - Country:US
Mailing Address - Phone:505-439-0523
Mailing Address - Fax:505-434-2559
Practice Address - Street 1:780 SCENIC DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4304
Practice Address - Country:US
Practice Address - Phone:505-439-0523
Practice Address - Fax:505-434-2559
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD18511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice