Provider Demographics
NPI:1609960517
Name:WARNER, JOHN BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRUCE
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 1:13420 NEWPORT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3745
Mailing Address - Country:US
Mailing Address - Phone:714-734-9519
Mailing Address - Fax:714-734-9536
Practice Address - Street 1:13420 NEWPORT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3745
Practice Address - Country:US
Practice Address - Phone:714-734-9519
Practice Address - Fax:714-734-9536
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice