Provider Demographics
NPI:1881756203
Name:WARREN DENTAL ASSOCIATES INC
Entity type:Organization
Organization Name:WARREN DENTAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:KERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:401-245-5825
Mailing Address - Street 1:634 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02809
Mailing Address - Country:US
Mailing Address - Phone:401-245-5825
Mailing Address - Fax:401-245-0936
Practice Address - Street 1:634 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02809
Practice Address - Country:US
Practice Address - Phone:401-245-5825
Practice Address - Fax:401-245-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN018711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1455 1OtherUHC
RI83864OtherBCRI
RIW012166Medicaid