Provider Demographics
NPI:1467628677
Name:STEPHEN M. WARNER, D.M.D.,P.C.
Entity Type:Organization
Organization Name:STEPHEN M. WARNER, D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-347-7540
Mailing Address - Street 1:54 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1281
Mailing Address - Country:US
Mailing Address - Phone:508-347-7540
Mailing Address - Fax:508-347-7540
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1281
Practice Address - Country:US
Practice Address - Phone:508-347-7540
Practice Address - Fax:508-347-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA121651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty