Provider Demographics
NPI:1104512599
Name:AEGIS DENTAL GROUP WARSAW, P.C.
Entity type:Organization
Organization Name:AEGIS DENTAL GROUP WARSAW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-549-9940
Mailing Address - Street 1:1005 ANCHORAGE RD
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-2281
Mailing Address - Country:US
Mailing Address - Phone:574-549-9940
Mailing Address - Fax:574-376-4055
Practice Address - Street 1:1005 ANCHORAGE RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-2281
Practice Address - Country:US
Practice Address - Phone:574-549-9940
Practice Address - Fax:574-376-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental