Provider Demographics
NPI:1770645103
Name:ENG, WARREN E (DDS,FAGD,PLLC)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:E
Last Name:ENG
Suffix:
Gender:M
Credentials:DDS,FAGD,PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2898 WESTINGHOUSE RD
Mailing Address - Street 2:SUITE 524
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8196
Mailing Address - Country:US
Mailing Address - Phone:607-739-3528
Mailing Address - Fax:607-739-5371
Practice Address - Street 1:2898 WESTINGHOUSE RD
Practice Address - Street 2:SUITE 524
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8196
Practice Address - Country:US
Practice Address - Phone:607-739-3528
Practice Address - Fax:607-739-5371
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0388421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice