Provider Demographics
NPI:1730301995
Name:WARREN, ROGER KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:KAY
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 1:4252 HIGHLAND DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2658
Mailing Address - Country:US
Mailing Address - Phone:801-278-3636
Mailing Address - Fax:
Practice Address - Street 1:4252 HIGHLAND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-2658
Practice Address - Country:US
Practice Address - Phone:801-278-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140497-99231223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics