Provider Demographics
NPI:1124010764
Name:WARNER, KATHY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:S
Last Name:WARNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MCHUGH BLVD
Mailing Address - Street 2:2D DENBN/NDC
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-2511
Mailing Address - Country:US
Mailing Address - Phone:910-451-2208
Mailing Address - Fax:910-451-8036
Practice Address - Street 1:315 MCHUGH BLVD
Practice Address - Street 2:2D DENBN/NDC
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2511
Practice Address - Country:US
Practice Address - Phone:910-451-2208
Practice Address - Fax:910-451-8036
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6666122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist