Provider Demographics
NPI:1811004682
Name:MARK J WARNER, DDS, INC
Entity Type:Organization
Organization Name:MARK J WARNER, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-422-7633
Mailing Address - Street 1:1291 OLIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3468
Mailing Address - Country:US
Mailing Address - Phone:707-422-7633
Mailing Address - Fax:
Practice Address - Street 1:1291 OLIVER RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-3468
Practice Address - Country:US
Practice Address - Phone:707-422-7633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty