Provider Demographics
NPI:1811041742
Name:WARREN, ROBB ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBB
Middle Name:ANDREW
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 1:4226 MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1938
Mailing Address - Country:US
Mailing Address - Phone:608-241-7999
Mailing Address - Fax:608-241-2910
Practice Address - Street 1:4226 MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1938
Practice Address - Country:US
Practice Address - Phone:608-241-7999
Practice Address - Fax:608-241-2910
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54140151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice