Provider Demographics
NPI:1184731036
Name:GREAT OAKS DENTISTRY PA
Entity type:Organization
Organization Name:GREAT OAKS DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:K
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-625-2583
Mailing Address - Street 1:1532 N WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:830-625-2583
Mailing Address - Fax:830-625-8299
Practice Address - Street 1:1532 N WALNUT AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-625-2583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2021-03-31
Deactivation Date:2019-10-22
Deactivation Code:
Reactivation Date:2021-03-31
Provider Licenses
StateLicense IDTaxonomies
TX15682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty