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DR. CHARLE A WARREN D.D.S.

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1477582948

Individual Registrant:
DR. CHARLE A WARREN D.D.S.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
301 SCOTT AVE  RUPERT, ID 83350-1800 US
Tel: 208-436-6406  Fax: 208-436-9678

Contact information for business:
PO BOX 338  RUPERT, ID 83350-0338 US
Tel: 208-436-6406  Fax: 208-436-9678

Registration Information:
NPI: 1477582948
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
IDD-1872

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
DELTA DENTAL1872ID01
BLUE CROSS6F670ID01
REGENCE BLUE SHIELD00001001235001
UNITED CONCORDIA43639801




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