Provider Demographics
NPI:1588004576
Name:WARNER, MADELINE LEAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:LEAH
Last Name:WARNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MADELINE
Other - Middle Name:LEAH
Other - Last Name:HOEG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:853 VALLEY AVE.J
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2492
Mailing Address - Country:US
Mailing Address - Phone:631-275-8501
Mailing Address - Fax:
Practice Address - Street 1:9862 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3873
Practice Address - Country:US
Practice Address - Phone:619-596-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63889122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program