Provider Demographics
NPI:1710964127
Name:WARDEN, PAUL JEFFREY (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JEFFREY
Last Name:WARDEN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 MEDICAL CENTER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2248
Mailing Address - Country:US
Mailing Address - Phone:615-893-7736
Mailing Address - Fax:615-898-1771
Practice Address - Street 1:1725 MEDICAL CENTER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2248
Practice Address - Country:US
Practice Address - Phone:615-893-7736
Practice Address - Fax:615-898-1771
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000030933204E00000X
TNDS70221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNFW1250315OtherFEDERAL DEA
TNFW5168895OtherFEDERAL DEA