Provider Demographics
NPI:1134347164
Name:ROBERT E. WARREN, DDS, APC
Entity type:Organization
Organization Name:ROBERT E. WARREN, DDS, APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-274-7691
Mailing Address - Street 1:625 E 34TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4154
Mailing Address - Country:US
Mailing Address - Phone:907-274-7691
Mailing Address - Fax:907-277-6142
Practice Address - Street 1:625 E 34TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4154
Practice Address - Country:US
Practice Address - Phone:907-274-7691
Practice Address - Fax:907-277-6142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK 4111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty