Provider Demographics
NPI:1154548469
Name:MICHAEL A. WARREN CAPTIAL INC
Entity type:Organization
Organization Name:MICHAEL A. WARREN CAPTIAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-935-9376
Mailing Address - Street 1:111 W WIGWAM BLVD
Mailing Address - Street 2:SUITE A
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:623-536-9884
Practice Address - Street 1:111 W WIGWAM BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4636
Practice Address - Country:US
Practice Address - Phone:623-935-9376
Practice Address - Fax:623-536-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD48401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty