Russell Scott Warren, DDS, M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

20878 Issued in TX

Practice address

103 Burnett CT
Woodway, TX 76712-3100

Phone

(254) 399-9925

Fax

(254) 399-9930

NPI assigned

Feb 2, 2008

Last updated

Sep 30, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2012 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brazos Oral & Facial Surgery, PA

  dba Brazos Oral & Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Waco, TX
  • NPI 1871316968
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222732800000",
    "number": "1386822237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 BURNETT CT",
            "city": "WOODWAY",
            "state": "TX",
            "postal_code": "767123100",
            "telephone_number": "254-399-9925",
            "fax_number": "254-399-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 BURNETT CT",
            "city": "WOODWAY",
            "state": "TX",
            "postal_code": "767123100",
            "telephone_number": "254-399-9925",
            "fax_number": "254-399-9930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "RUSSELL",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DDS, M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-02",
        "last_updated": "2008-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "20878",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "TX",
            "license": "M9730",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth B Waite, D.O.
• Walgreen Co (Walgreens #09648)
• Walgreens
• Dalton Garrett Walker, PA-C
• Jennifer Anne Wallace, LPC
• Mya Breann Washington
• Cortney Weaver
• Taylor N Weaver
• Barbara D Weir, APRN
• Garrett Welch, OTR

• Oral and Maxillofacial Surgery (Dentist) in Woodway, TX
• Providers in Woodway, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.