Provider Demographics
NPI:1730863572
Name:WARREN & HAGERMAN DENTAL PLLC
Entity type:Organization
Organization Name:WARREN & HAGERMAN DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-935-9376
Mailing Address - Street 1:111 W WIGWAM BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4636
Mailing Address - Country:US
Mailing Address - Phone:623-935-9376
Mailing Address - Fax:
Practice Address - Street 1:111 W WIGWAM BLVD STE A
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4636
Practice Address - Country:US
Practice Address - Phone:602-692-8312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental