Provider Demographics
NPI:1396033957
Name:MAHARREY, WARREN BLAKE (DMD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:BLAKE
Last Name:MAHARREY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6309
Mailing Address - Country:US
Mailing Address - Phone:662-842-8200
Mailing Address - Fax:662-844-3157
Practice Address - Street 1:1043 S MADISON ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6309
Practice Address - Country:US
Practice Address - Phone:662-842-8200
Practice Address - Fax:662-844-3157
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3624-111223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery