Provider Demographics
NPI:1023189305
Name:WARNER, RICHARD EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EUGENE
Last Name:WARNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9179 W THUNDERBIRD RD
Mailing Address - Street 2:STE. B-107
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4875
Mailing Address - Country:US
Mailing Address - Phone:623-933-6010
Mailing Address - Fax:623-933-6523
Practice Address - Street 1:9179 W THUNDERBIRD RD
Practice Address - Street 2:STE. B-107
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4875
Practice Address - Country:US
Practice Address - Phone:623-933-6010
Practice Address - Fax:623-933-6523
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ26111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice