Provider Demographics
NPI:1710052279
Name:MASSEY, WARREN COLEMAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:COLEMAN
Last Name:MASSEY
Suffix:
Gender:M
Credentials:DDS, MS
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3089 E MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4385
Mailing Address - Country:US
Mailing Address - Phone:479-442-6995
Mailing Address - Fax:449-443-6468
Practice Address - Street 1:3089 E MISSION BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4385
Practice Address - Country:US
Practice Address - Phone:479-442-6995
Practice Address - Fax:449-443-6468
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR20591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry