Provider Demographics
NPI:1518074533
Name:WARNER, SCOTT A (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:WARNER
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 1:984 MONUMENT ST
Mailing Address - Street 2:STE 207
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272
Mailing Address - Country:US
Mailing Address - Phone:310-459-7861
Mailing Address - Fax:310-230-1031
Practice Address - Street 1:984 MONUMENT ST
Practice Address - Street 2:STE 207
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272
Practice Address - Country:US
Practice Address - Phone:310-459-7861
Practice Address - Fax:310-230-1031
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA36296OtherCA DENTAL ASSOCIATION