Provider Demographics
NPI:1114931656
Name:WARNOCK, ERIC WAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WAYNE
Last Name:WARNOCK
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 1:959 ILLINOIS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1743
Mailing Address - Country:US
Mailing Address - Phone:419-891-0527
Mailing Address - Fax:419-891-0719
Practice Address - Street 1:959 ILLINOIS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1743
Practice Address - Country:US
Practice Address - Phone:419-891-0527
Practice Address - Fax:419-891-0719
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice