Provider Demographics
NPI:1033673033
Name:WARNER DENTAL GROUP
Entity Type:Organization
Organization Name:WARNER DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-275-8501
Mailing Address - Street 1:3638 OCEAN RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-2669
Mailing Address - Country:US
Mailing Address - Phone:760-237-4050
Mailing Address - Fax:
Practice Address - Street 1:3638 OCEAN RANCH BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-2669
Practice Address - Country:US
Practice Address - Phone:760-237-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty