Provider Demographics
NPI:1215184338
Name:BERNE, WARREN GARY (DMD)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:GARY
Last Name:BERNE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:WARREN
Other - Middle Name:G
Other - Last Name:BERNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:203 WOODPARK PL
Mailing Address - Street 2:SUITE B-102
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3705
Mailing Address - Country:US
Mailing Address - Phone:770-926-0021
Mailing Address - Fax:770-926-0919
Practice Address - Street 1:203 WOODPARK PL
Practice Address - Street 2:SUITE B-102
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3705
Practice Address - Country:US
Practice Address - Phone:770-926-0021
Practice Address - Fax:770-926-0919
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA113651223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics