Provider Demographics
NPI:1942579529
Name:PAIGE P. WARREN DMD PSC
Entity Type:Organization
Organization Name:PAIGE P. WARREN DMD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-667-7301
Mailing Address - Street 1:125 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:42450-1268
Mailing Address - Country:US
Mailing Address - Phone:270-667-7301
Mailing Address - Fax:270-667-7630
Practice Address - Street 1:125 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:KY
Practice Address - Zip Code:42450-1268
Practice Address - Country:US
Practice Address - Phone:270-667-7301
Practice Address - Fax:270-667-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY71941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60071941Medicaid