Provider Demographics
NPI:1184796013
Name:WARDEN, MARK ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:WARDEN
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 1:104 EAST PARK DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7535
Mailing Address - Country:US
Mailing Address - Phone:615-373-8307
Mailing Address - Fax:615-373-6920
Practice Address - Street 1:104 EASTPARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7535
Practice Address - Country:US
Practice Address - Phone:615-373-8307
Practice Address - Fax:615-373-6920
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000033391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice