Provider Demographics
NPI:1821037235
Name:WARREN DENTAL ARTS, INC
Entity Type:Organization
Organization Name:WARREN DENTAL ARTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-723-4488
Mailing Address - Street 1:128 PENNSYLVANIA AVE E
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2533
Mailing Address - Country:US
Mailing Address - Phone:814-723-4488
Mailing Address - Fax:814-723-0769
Practice Address - Street 1:128 PENNSYLVANIA AVE E
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2533
Practice Address - Country:US
Practice Address - Phone:814-723-4488
Practice Address - Fax:814-723-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty