Provider Demographics
NPI:1780691055
Name:WARREN, MARK BOYD (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:BOYD
Last Name:WARREN
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 1:394 S 400 E
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-8116
Mailing Address - Country:US
Mailing Address - Phone:801-754-1281
Mailing Address - Fax:801-465-5130
Practice Address - Street 1:675 S 100 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2883
Practice Address - Country:US
Practice Address - Phone:801-465-1390
Practice Address - Fax:801-465-5130
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT534245599221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice