Provider Demographics
NPI:1356717524
Name:WARREN, JOHN CARMEN (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARMEN
Last Name:WARREN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618TH DENTAL COMPANY, USA DENTAC - KOREA
Mailing Address - Street 2:UNIT # 15652
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205
Mailing Address - Country:US
Mailing Address - Phone:315-737-2600
Mailing Address - Fax:
Practice Address - Street 1:618TH DENTAL COMPANY, USA DENTAC - KOREA
Practice Address - Street 2:UNIT # 15652
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205
Practice Address - Country:US
Practice Address - Phone:315-737-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040365122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist