Provider Demographics
NPI:1073658191
Name:WARNICA, SCOTT DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:WARNICA
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 1:12409 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-3101
Mailing Address - Country:US
Mailing Address - Phone:509-924-4411
Mailing Address - Fax:509-924-2747
Practice Address - Street 1:12409 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3101
Practice Address - Country:US
Practice Address - Phone:509-924-4411
Practice Address - Fax:509-924-2747
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000090241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5036975Medicaid
WA151634OtherLABOR & INDUSTRIES